Implementing the SAFE Principles for the Development of Pain Medicine Therapeutic Algorithms That Include Neuromodulation Techniques.

TLDR: A new model of thinking is offered when formulating algorithms of care that might include more invasive and costly interventions such as spinal cord stimulation, the SAFE principles.

Abstract: Currently accepted chronic pain treatment algorithms have positioned therapies according to levels of invasiveness and up-front costs. After reviewing updated literature on efficacy and cost outcomes of care for patients with chronic pain that include interventional implantable technologies, we offer a new model of thinking when formulating algorithms of care that might include more invasive and costly interventions such as spinal cord stimulation, the SAFE principles. These SAFE principles include "safety," "appropriateness," "fiscal neutrality," and "efficacy." Introductiontraditional role of the physician is to heal patients. To accomplish this goal, the physician synthesizes his or her knowledge base derived from education, experience, and extrapolation of the medical and scientific literature into an appropriate treatment plan. In this traditional model, accepted medical treatment is based on safety of the intervention, appropriateness to the diagnosis and individual patient, and effectiveness. In today's world of rapidly growing therapeutic options and increasing medical cost, the role of the physician has expanded to encompass consideration of cost-utility in an attempt to maximize the benefit for their patients in an environment of limited healthcare resources. In government-sponsored healthcare systems, government agencies dictate the allocation of care based on known efficacy data/safety, cost, and available resources. In the United States, health care for the insured patient is also limited by cost. Hospitals routinely deny certain therapies and technologies because of inadequate reimbursement, and third-party payers, including private and public payers; for example, the Centers for Medicare and Medicaid Services use cost to dictate the spectrum of medical coverage.