MEDICAL COMMENTARY
Implementing the SAFE Principles for the Development of Pain Medicine Therapeutic Algorithms That Include Neuromodulation Techniques
Elliot Krames MD,
Lawrence Poree MD, PhD,
Timothy Deer MD,
Robert Levy MD,
Elliot Krames MD
Pacific Pain Treatment Centers, San Francisco, CA, USA;
Search for more papers by this authorLawrence Poree MD, PhD
Pacific Pain Treatment Centers, San Francisco, CA, USA;
Pain Clinic of Monterey Bay, Aptos, CA, USA;
Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA;
Search for more papers by this authorTimothy Deer MD
Center for Pain Relief Inc., Charleston, WV, USA;
West Virginia University School of Medicine, Morgantown, WV, USA;
Search for more papers by this authorRobert Levy MD
Departments of Neurologic Surgery and Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
Search for more papers by this authorElliot Krames MD,
Lawrence Poree MD, PhD,
Timothy Deer MD,
Robert Levy MD,
Elliot Krames MD
Pacific Pain Treatment Centers, San Francisco, CA, USA;
Search for more papers by this authorLawrence Poree MD, PhD
Pacific Pain Treatment Centers, San Francisco, CA, USA;
Pain Clinic of Monterey Bay, Aptos, CA, USA;
Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA;
Search for more papers by this authorTimothy Deer MD
Center for Pain Relief Inc., Charleston, WV, USA;
West Virginia University School of Medicine, Morgantown, WV, USA;
Search for more papers by this authorRobert Levy MD
Departments of Neurologic Surgery and Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
Search for more papers by this authorAddress correspondence and reprint requests to: Elliot Krames, MD, Pacific Pain Treatment Centers, San Francisco, CA 94109, USA. Email: [email protected]
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.”
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