Spinal cord stimulation (SCS) is a therapeutic approach used for the management of chronic pain. It involves the delivery of electrical impulses to the spinal cord via an implanted device, which when given suitable stimulus parameters can mask or block pain signals. Selection of optimal stimulation parameters usually happens in the clinic under the care of a provider whereas at-home SCS optimization is managed by the patient. In this paper, we propose a recommender system for the management of pain in chronic pain patients undergoing SCS. In particular, we use a contextual multi-armed bandit (CMAB) approach to develop a system that recommends SCS settings to patients with the aim of improving their condition. These recommendations, sent directly to patients though a digital health ecosystem, combined with a patient monitoring system closes the therapeutic loop around a chronic pain patient over their entire patient journey. We evaluated the system in a cohort of SCS-implanted ENVISION study subjects (Clinicaltrials.gov ID: NCT03240588) using a combination of quality of life metrics and Patient States (PS), a novel measure of holistic outcomes. SCS recommendations provided statistically significant improvement in clinical outcomes (pain and/or QoL) in 85\% of all subjects (N=21). Among subjects in moderate PS (N=7) prior to receiving recommendations, 100\% showed statistically significant improvements and 5/7 had improved PS dwell time. This analysis suggests SCS patients may benefit from SCS recommendations, resulting in additional clinical improvement on top of benefits already received from SCS therapy.

翻译：脊髓电刺激（SCS）是一种用于治疗慢性疼痛的治疗方法，通过植入式装置向脊髓传递电脉冲，在合适的刺激参数下可掩盖或阻断疼痛信号。最佳刺激参数的选择通常在临床医护人员的指导下进行，而居家SCS优化则由患者自行管理。本文提出了一种针对接受SCS治疗的慢性疼痛患者的疼痛管理推荐系统。具体而言，我们采用上下文多臂老虎机（CMAB）方法开发了一个系统，向患者推荐SCS设置以改善其病情。这些推荐通过数字健康生态系统直接发送给患者，结合患者监测系统，形成围绕慢性疼痛患者整个治疗过程的闭环治疗。我们在一组植入SCS的ENVISION研究受试者（Clinicaltrials.gov ID: NCT03240588）中，结合生活质量指标和患者状态（PS）——一种新型整体结局衡量标准，对系统进行了评估。SCS推荐在85%的受试者（N=21）中实现了临床结局（疼痛和/或生活质量）的统计学显著改善。在接收推荐前处于中等PS状态的受试者（N=7）中，100%显示出统计学显著改善，其中5/7名受试者的PS停留时间得到改善。本分析表明，SCS患者可能从SCS推荐中获益，在已从SCS治疗获得的益处基础上，进一步实现临床改善。