title: Impact of wait times on spinal cord stimulation therapy outcomes.
abstract: OBJECTIVE
  Presently, the long-term success rate of spinal cord stimulation (SCS) ranges from 47% to 74%. SCS efficacy is inversely proportional to the passage of time between development of chronic pain syndrome and time of implantation. To improve outcomes, implantation should be performed early. This study identifies sources of delay and offers suggestions for improvement.
  
  
  METHODS
  A retrospective analysis of 437 SCS patients examines delays to accessing SCS at various points in the referral stream, from initial diagnosis, family physician, and various specialist treatments, to implantation. Analysis of variance evaluated the effect of age, sex, treating specialty, and their interactions on implantation delay. A multiple linear regression model was developed to assess factors contributing to implantation delay.
  
  
  RESULTS
  From time of onset of chronic pain to implantation, patients endured a delay of 65.4 ± 2.04 months. Initial physician contact occurred at a mean of 3.4 ± 0.12 months after development of pain syndrome. Family physicians managed cases for 11.9 ± 0.45 months and various specialists for an additional 39.8 ± 1.22 months. Neurosurgeons were quickest to refer to an implant physician (average wait-time 32.28 ± 2.64 months), while orthopedic surgeons and nonimplanting anesthesiologists took the longest, contributing to wait times of 51.60 ± 5.04 months and 58.08 ± 5.76 months, respectively. Once the decision for implantation was made, the implanting physician required 3.31 ± 0.09 months to organize the procedure. A gradual decline in wait times was observed from 1980 to present.
  
  
  CONCLUSIONS
  To improve SCS success rates, physicians involved in the treatment for chronic pain should refer these cases early to an implant physician once failure of medical management becomes apparent.
authors.affiliation: Department of Neurosurgery, University of Saskatchewan, Regina, SK, Canada.
authors.forename: Krishna
authors.initials: K
authors.lastname: Kumar
authors.forename: Syed
authors.initials: S
authors.lastname: Rizvi
authors.forename: Rita
authors.initials: R
authors.lastname: Nguyen
authors.forename: Mariam
authors.initials: M
authors.lastname: Abbas
authors.forename: Sharon
authors.initials: S
authors.lastname: Bishop
authors.forename: Vignesh
authors.initials: V
authors.lastname: Murthy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy / Q000379:methods; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods; D012189:Retrospective Studies; D013116:Spinal Cord / Q000502:physiology*; D062187:Spinal Cord Stimulation; D013995:Time; D016896:Treatment Outcome
keywords: chronic pain; long-term efficacy; points of delay in implantation; spinal cord stimulation; wait times