To Trial or not to Trial

This session explores the ongoing debate about trial vs. no trial before spinal cord stimulation (SCS) implantation. Historically mandated by NICE and NIH, trials aim to predict long-term outcomes, but recent evidence challenges their necessity. A 2022 RCT found no significant difference in pain, quality of life, or adverse events between trial and no-trial groups at 36 months, though limitations included high dropout rates and marginal statistics. Current guidelines still recommend trials—preferably percutaneous—for patient selection, reducing long-term failure and costs. Future strategies may involve AI prediction models and wireless technology to improve patient selection and streamline processes.