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Spinal cord stimulator education during pain fellowship: unmet training needs and factors that impact future practice
  1. Daniel J Pak1,
  2. Jesse Gruber2,
  3. Timothy Deer3,
  4. David Provenzano4,
  5. Amitabh Gulati5,
  6. Yifan Xu2,
  7. Virginia Tangel2 and
  8. Neel Mehta2
  1. 1 Department of Anesthesiology, Harvard Medical School, Massachusetts General Hospita, Boston, Massachusetts, USA
  2. 2 Department of Anesthesiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, USA
  3. 3 The Spine and Nerve Center of the Virginias, Charleston, West Virginia, USA
  4. 4 Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, USA
  5. 5 Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, USA
  1. Correspondence to Dr Neel Mehta, Department of Anesthesiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY 10065, USA; nem9015{at}


Background and objectives With a growing need for non-opioid chronic pain treatments, pain physicians should understand the proper utilization of neuromodulation therapies to provide the most comprehensive care. We aimed to identify the unmet training needs that deter physicians from using spinal cord stimulation (SCS) devices.

Methods Internet-based surveys were fielded to fellows enrolled in pain fellowships during the 2016–2017 academic year accredited by the Accreditation Council for Graduate Medical Education and past pain fellows identified through pain medicine societies and SCS manufacturers.

Results Current fellows were more likely to have received SCS training during fellowship compared with past fellows (100.0% vs 84.0%), yet there was variability in fellows’ SCS experiences with a wide range of trials and implants performed. Forty-six percent of current fellows felt there was an unmet training need regarding SCS. Deficiency in SCS case volume was the most common barrier that was noted (38.5%), followed by lack of SCS curriculum (30.8%) and lack of faculty with SCS expertise (23.1%). Lack of training was a predominant reason for past fellows choosing not to use SCS devices postfellowship. The majority of current and past fellows (79.5% and 55.4%, respectively) strongly supported direct training of fellows by SCS manufacturers.

Conclusions While SCS training during pain fellowship has become more universal, the experiences that fellows receive are highly variable, and most rely on industry-sponsored programs to supplement training deficiencies. Standardization of SCS procedures may also enable less experienced providers to navigate the SCS treatment algorithm.

  • spinal cord stimulation
  • neuromodulation
  • pain fellowship
  • training curriculum

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  • Presented at Interim data from this work were presented at the 42nd Annual 2017 Regional Anesthesiology and Acute Pain Medicine Meeting in San Francisco, California, from 6 April to 8 April 2017.

  • Funding This survey has received a total of $15 000 unrestricted funding from Boston Scientific, Medtronic and Nevro Corp ($5000). All companies in neuromodulation were invited to fund this investigator-initiated study. All final design, protocol implementation and results were under direct control of the investigators. Funding was used for initial costs of survey design and setup, Institutional Review Board Fees, statistical review and travel to conferences for presentation.

  • Competing interests DP consults for Abbott, Bioness, Boston Scientific, Halyard, Medtronic, Sollis and Nevro Corp. He receives research support from Abbott and Medtronic. TD consults for Abbott, Bioness, Nalu, Vertiflex, Vertos, Jazz, Flowonix and Saluda. TD also has minor equity in Axonics, Saluda, Bioness, Vertos, Vertiflex and Nalu and research support from Abbott, Saluda and Mainstay. AG consults for Medtronic. NM consults for Nevro Corp, Sollis and Biodelivery Sciences. He receives research support from Medtronic and Nevro Corp.

  • Patient consent for publication Not required.

  • Ethics approval After Institutional Review Board (Weill Cornell Medical College, protocol #1507016431) approval was obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.