Comparison of knowledge and awareness of epilepsy between medical students of two universities in Poland.

BACKGROUND: Epilepsy is one of the most common neurological disorders. As a chronic disease, associated with long-term treatment with antiseizure medication, it can have a negative impact on patients' quality of life. Moreover, patients are faced with a significant psychosocial burden associated with the stigma surrounding epilepsy. Medical professionals should be well educated and free of prejudices in order to provide adequate care for patients with epilepsy. The aim of the study was to evaluate the knowledge and awareness of epilepsy among medical students of years 1-6 in Poland and examine if certain personality traits influence students' view of epilepsy. METHODS: The study was conducted using snowball sampling of 166 Polish medical students from Medical University of Gdansk and Medical University of Warsaw. Participants completed a survey which consisted of their subjective assessment of knowledge of epileptology, actual knowledge of epileptology, and their view of stereotypes about epilepsy. In addition, students completed the IPIP-BFM-20 personality questionnaire. RESULTS: Polish medical students have sufficient basic knowledge about epilepsy (mean scores of students from both universities is 14 out of 25 points). There is still room for improvement, especially in the field of epidemiology, semiology, factors provoking seizures, antiseizure medications, and most importantly about first aid during seizure (e.g., 7% of respondents believed it is necessary to put something between teeth of a patient during seizure). Age and the year of study were well correlated with knowledge score (p = 0.008) and level of awareness of the stereotypes. We found that most personality traits do not have a strong impact on the level of knowledge about epilepsy. CONCLUSIONS: Most students have a satisfying level of knowledge about epilepsy. Academic teachers should put more emphasis on first aid during seizures and awareness of psychosocial challenges associated with the disease. It is crucial for future physicians to not only possess sufficient theoretical knowledge, but also establish an empathetic doctor-patient relationship in order to provide better care for patients with epilepsy and other chronic diseases.

Seasonal changes of internet searching suggest circannual rhythmicity of primary headache disorders.

OBJECTIVE: To investigate whether web searching for headache disorders presents some circannual rhythm. BACKGROUND: Studies support the influence of seasonal rhythms in primary headache disorders such as cluster headache (CH) and episodic migraine. We investigated whether internet users' searching for headaches reflect these circannual rhythms. METHODS: This was an internet-based study using the Google Trends (Google) platform. The 10-year interest across four related topics (headache, migraine, tension-type headache [TTH], and CH) in 31 European countries was scanned. RESULTS: Significant differences between months were found for the topics "headache" and "migraine." Interest in the former was superior in February (median for all countries, 61 [25th-75th percentile, 45-80]), October (61 [44-75]), and November (61 [45-76]). The lowest search volumes for headache appeared in July (52 [37-66]) (p < 0.001). Migraine was searched most commonly in November (56 [40-73]) and rarely in June (46.5 [31-64]) (p < 0.001). Differences were observed for the topic of headache in Northern Europe (p = 0.001) and for headache and migraine in Central Europe (p < 0.001 and p = 0.016 respectively) but not in the southern region. TTH and CH were apparently less searched and no evident trends regarding them were present (median, 22 [0-44] for TTH and 15 [0-33] for CH; direct popularity comparison: headache 56 [44-63], migraine 16 [12-24], TTH 2 [1-2], and CH 2 [1-2]; between-month differences, p = 0.168 and p = 0.081 respectively). CONCLUSIONS: Public attention on headache-related topics on the internet is distributed according to a significant trend of increased searching around spring and autumn. It suggests that a large number of patients may experience some level of seasonal variation in their headaches. Assessment of whether those temporal changes are present in clinical practice is necessary.

Epilepsy awareness among school-aged students in Poland.

OBJECTIVE: Epilepsy can be a well-controlled condition with only a slight impact on patients' life. Lack of knowledge within society contributes to children with epilepsy experiencing discrimination and hostility. The aim of this study was to evaluate the awareness of epilepsy and general views on people struggling with this disease among school-aged children. METHODS: The study was conducted on a random sample of Polish school students, in total 472 participants. Participants' knowledge was assessed by a self-completed survey. RESULTS: Students are unaware of the wide range of symptoms occurring during seizures. More than half claimed that people experiencing epilepsy should not perform sports activities. Alarmingly, 30% of participants believe that those patients should not leave the house and they should be excluded from many jobs. Almost all participants would help a person experiencing seizures and remember proper head protection; shockingly, 20% of children would try to put something in the person's mouth. Older students seem to be better educated on epilepsy, but the percentage of incorrect personal beliefs and myths is similar for each age group. SIGNIFICANCE: School-aged students have insufficient knowledge of epilepsy. More emphasis should be put on first aid during seizures and on the spectrum of epilepsy symptoms. Educating society is important for life quality of people experiencing epilepsy.

COVID-19 pandemic influence on epilepsy course in pediatric patients.

INTRODUCTION: In 2020, Coronavirus Disease 2019 (COVID-19) was declared as a global pandemic. Self-reported stress, anxiety, and insomnia, which are believed to be common triggers for epilepsy, are more likely to occur. We aimed to establish the influence of COVID-19 pandemic itself on changes in the daily life routine related to pandemic on epilepsy course in pediatric patients. The unique form of clinical care which is telemedicine was also taken into consideration. We wanted to evaluate patients' satisfaction with telemedicine and if changing stationary visits into telemedicine influenced epilepsy course in our patients. METHODS: Patients, who attended developmental neurology outpatient clinic in the period March-December 2020 were collected. As patients were minors, legal guardians were asked to fill out the questionnaire. Patients were divided according to the outcome into three groups: those with a worsened, stable, or improved course of epilepsy during the pandemic. Appropriate statistical tests for two-group and multi-group comparisons have been implemented. Post hoc p values were also calculated. RESULTS: Four hundred and two questionnaires were collected. Most of the patients had a stable course of epilepsy during the pandemic; in 13% of participants an improvement has been observed, worsening of the disease was seen in 16% of patients. Age, sex, type of epilepsy, number of seizure incidents before pandemic, and duration of the disease had no statistically significant connection with changes in the course of the disease. Behavioral changes and altered sleep patterns were found to be more common in the worsened group. Fifty-eight percent of patients were satisfied with telemedicine. Poorer satisfaction was connected with less frequent visits, cancellation of scheduled appointments, and lack of help in case of need in an emergency situation. CONCLUSION: Epilepsy course in pediatric patients seems to be stable during COVID-19 pandemic. Sleep disturbances and changes in a child's behavior may be related to increase in seizure frequency. Telemedicine is an effective tool for supervising children with epilepsy. Patients should be informed about possible ways of getting help in urgent cases.

Internet searches for "suicide", its association with epidemiological data and insights for prevention programs.

BACKGROUND: Literature demonstrates that analysis of internet search data is a useful tool in predicting the occurrence of illnesses and health-related behaviors. The aim of the study was to quantitatively present the trends in Google searches for the keyword "suicide" and to analyze its correlation with the number of suicides in Poland. SUBJECTS AND METHODS: We used the Google Trends tool to compile data for years 2004-2016. Statistical analysis was performed for annual, monthly, daily and hourly data. Official data on suicide in Poland were obtained from the Central Statistical Office and the General Police Headquarters of Poland. RESULTS: A gradual decrease in Google Relative Search Volume of the keyword "suicide" was observed in years 2004-2014, despite the significant increase of suicide rate in Poland (R=-0.24). Reverse correlation was also found between regional suicide coefficients and search volume (R=-0.22). The highest search volumes were recorded in winter months, first days of the week and at night hours (p<0.001). CONCLUSIONS: Presented results may contribute to more effective suicide prevention programs. By specifying the time intervals in which searching suicide information is the highest, it will become easier get to individuals at risk.

Colour contrasting between tissues predicts the resection in 5-aminolevulinic acid-guided surgery of malignant gliomas.

Due to the various intensities of 5-aminolevulinic acid (5-ALA) fluorescence, neurosurgeons tend to be uncertain about which tissues to resect. This study aimed to reveal the shortcomings of the human visual perception of fluorescence, particularly the factors guiding the tissue removal and the correlation of fluorescence with contrast enhancement (CE) on magnetic resonance imaging (MRI). Various colour features [CIE L*a*b* colour space, colour difference described by ΔE and contrast ratio (CR)] of total 206 noticed fluorescent areas and their surroundings were measured from the video recordings of 21 primary high grade glioma (HGG) surgeries. The position of a fluorescent region was related to the corecorded navigational image. Following early postoperative MRI, 17 additional regions of corresponding to CE remnants were identified, their colour features were compared to the resected CEs. The targeted video post-processing method was designed, based on the results. There were no complications attributed to 5-ALA use and the median survival was <10 months. 82.5 % of recognised fluorescent areas were removed. Colour spaces of the resected regions and their backgrounds did not overlap. Opposite to the separate colour components (p > 0.05), the distant background colour (p < 0.05) and higher CR and ΔE (p < 0.01) determined the resection of a fluorescent region. Noneloquent location and CR both independently increased the resection rate in logistic regression. However, greater area under the receiver operating characteristic curve (AUC) in case of CR (AUC = 0.78; 95 % CI 0.71-0.83) determined its dominant role in neurosurgeon's fluorescence perception. CE regions presented with a significantly more saturated shade of violet (consistently higher a* and b*) than other tumour parts (p < 0.05). Regions corresponding to tumour remnants had a significantly lower a* component value (p = 0.02) as well as a lower ΔE than the matched background (AUC = 0.73; 95 % CI 0.65-0.80). In order to increase the resection rate, ΔE > 60 was needed. These results directed essential improvements in the 5-ALA fluorescence visualisation toward enhanced resection rate. The conventional filtering, unadjusted to the 5-ALA colour space converted some background shades to colours resembling relevant fluorescence. This is one of the first studies to demonstrate that perceived colours, their contrasting and CR are of significance in the decision-making during HGG 5-ALA fluorescence-guided surgery. Irrespective of the shortcomings of conventional video filtering, further development of a tailored post-processed contrast stretching will allow to achieve safe and radical tumour resection.

The challenges of hypervolemic therapy in patients after subarachnoid haemorrhage.

PURPOSE: The triple-H therapy is widely used for cerebral vasospasm (CV) prevention and treatment in patients after subarachnoid haemorrhage (SAH). However, this practice is based on low level evidence. Aim of this study was to evaluate errors in fluid administration, fluid balance monitoring and bedside charts completeness during a trial of triple-H therapy. MATERIALS AND METHODS: An audit of the SAH patient charts was performed. A total of 508 fluid measurements were performed in 41 patients (6 with delayed cerebral ischaemia; DCI) during 14 days of observation. RESULTS: Underestimating for intravenous drugs was the most frequent error (80.6%; 112), resulting in a false positive fluid balance in 2.4% of estimations. In 38.6% of the negative fluid balance cases, the physicians did not order additional fluids for the next 24h. In spite of that, the fluid intake was significantly increased after DCI diagnosis. The mean and median intake values were 3.5 and 3.8l/24h respectively, although 40% of the fluid balances were negative. The positive to negative fluid balance ratio was decreasing in the course of the 14 day observation. CONCLUSIONS: This study revealed inconsistencies in the fluid orders as well as mistakes in the fluid monitoring, which illustrates the difficulties of fluid therapy and reinforces the need for strong evidence-based guidelines for hypervolemic therapy in SAH.

Evaluating the Credibility and Reliability of Online Information on Cannabidiol (CBD) for Epilepsy Treatment in Poland.

The interest in the potential therapeutic use of cannabis, especially cannabidiol (CBD), has increased significantly in recent years. On the Internet, users can find lots of articles devoted to its medical features such as reducing seizure activity in epilepsy. The aim of our work was to evaluate the information contained on the websites, including social media, in terms of the credibility and the reliability of current knowledge about the usage of products containing cannabidiol in epilepsy treatment. We used online available links found using the Newspointtool. The initial database included 38,367 texts, but after applying the inclusion and exclusion criteria, 314 texts were taken into consideration. Analysis was performed using the DISCERN scale and the set of questions created by the authors. In the final assessment, we observed that most of the texts (58.9%) were characterized by a very poor level of reliability and the average DISCERN score was 26.97 points. Additionally, considering the form of the text, the highest average score (35.73) came from entries on blog portals, whereas the lowest average score (18.33) came from comments and online discussion forums. Moreover, most of the texts do not contain key information regarding the indications, safety, desired effects, and side effects of CBD therapy. The study highlights the need for healthcare professionals to guide patients towards reliable sources of information and cautions against the use of unverified online materials, especially as the only FDA-approved CBD medication, Epidiolex, differs significantly from over-the-counter CBD products.

Increased risk of death compared to other antipsychotics in elderly clozapine users in Poland.

Clozapine can cause severe adverse effects. Few epidemiologic studies have considered the effect of clozapine use in elderly patients. The aim of this study was to assess mortality in elderly patients treated with clozapine in comparison to patients treated with first- or second-generation antipsychotics. We conducted a retrospective cohort study involving 26 639 patients who were 65 years of age or older and were receiving antipsychotic medication between 2008 and 2012. Cox proportional-hazards models were used to compare the risk of death between different groups of antipsychotics after controlling for age, sex, concomitant treatment with cardiovascular or metabolic medications. The use of antipsychotic medications other than clozapine was associated with a lower adjusted risk of death [hazard ratio, 0.89; 95% confidence interval (95% CI), 0.79-0.99]. The use of cardiac and antilipemic but not antidiabetic drugs was associated with a significantly lower risk of death in this population (hazard ratio, 0.88; 95% CI, 0.83-0.93; hazard ratio, 0.66; 95% CI, 0.58-0.75 and hazarad ratio, 1.09; 95% CI, 0.96-1.24, respectively). These results suggest that clozapine is associated with an increased risk of death in the elderly. Although the study was based on administrative records linkage, its results suggest that attention should be paid to patients taking antipsychotics.

Social Media as a Source of Knowledge about Gene Therapy for Spinal Muscular Atrophy.

Social media is one of the most common sources of medical information. We aimed to evaluate the information contained on websites, including social media and descriptions of fundraisers, in terms of the reliability of knowledge about SMA and gene therapy with onasemnogen abeparvovec. We used a set of available online links found using the Newspointtool. Initially, 1525 texts were included in the study, and after applying the inclusion and exclusion criteria, 112 texts were qualified for analysis using the DISCERN scale and the set of questions prepared by the authors. We observed that most of the texts had poor (48.65%) and medium (27.03%) reliability in the final reliability assessment. All the texts selected for the study were related to gene therapy, although few contained key information about it. In addition, the authors of the entries used various words and phrases that influenced the readers' perceptions of the text. Of the analyzed sources, 68.8% had an emotional component. Social media is a poor source of information about gene therapy for SMA in Poland. The analyzed texts do not provide a full and complete description of the SMA problem. However, it is important to remember that the Internet is a changing source of information and will hopefully contain more relevant entries in the future.

Self-Assessed Personality Traits and Adherence to the COVID-19 Lockdown.

Introduction: The COVID-19 pandemic, caused by the SARS-CoV-2 coronavirus, has forced all countries affected by it to introduce quarantine and isolation to prevent the spread of the virus, as well as masking and distancing. Not everyone is equally willing to follow the rules related to limit the extent of the coronavirus epidemic. This might be connected with personality traits, especially openness, positive attitude, and optimism. Materials and Methods: An online survey was created and completed by participants in April-May 2020. Self-assessment of personality traits and adherence to lockdown recommendations were assessed. A total of 7404 participants took part in the study, mainly from Poland (83.6%) and Italy (12.7%). Univariate and multivariate regression analysis was performed. Results: The participants were divided into groups depending on the degree of compliance with the lockdown rules. In the multivariate analysis, variables that increased the odds for stricter lockdown compliance were temporary work suspension OR 1.27 (95% CI 1.10-1.48), income level "we can't handle this situation" OR 1.67 (95%CI 1.20-2.33), and junior high school education OR 1.68 (95% CI 1.13-2.50). Other significant factors included age and place of residence. Each point of self-assessed sociability OR 1.07 (95% CI 1.00-1.13) also increased the likelihood of adhering to lockdown rules. Conclusions: Taking the basic demographic characteristics as well as working and health environment conditions traits into account may be helpful when forecasting epidemiological compliance during a pandemic, as well as in other public health tasks. The key role of self-assessed personality traits was not confirmed in this study. Reliability of the results is limited by significant disproportions in the size of the study groups.

Social Isolation During COVID-19 Pandemic. Perceived Stress and Containment Measures Compliance Among Polish and Italian Residents.

BACKGROUND: In this study, we analyze the association of social isolation in the first phase of the pandemic with perceived stress among residents of Poland and Italy with a look at how these populations adjust to and comply with implemented regulations, guidelines, and restrictions. MATERIALS AND METHODS: Internet survey with Perceived Stress Scale (PSS-10) and questions regarding mobility patterns, attitude, and propensity to adjust toward the implemented measures and current health condition was made among Polish and Italian residents (Cronbach's alpha 0.86 and 0.79, respectively). The sample size was 7,108 (6,169 completed questionnaires in Poland and 939 in Italy). RESULTS: The Polish group had a higher stress level than the Italian group (mean PSS-10 total score 22,14 vs 17,01, respectively; p < 0.01). There was a greater prevalence of chronic diseases among Polish respondents. Italian subjects expressed more concern about their health, as well as about their future employment. Italian subjects did not comply with suggested restrictions as much as Polish subjects and were less eager to restrain from their usual activities (social, physical, and religious), which were more often perceived as "most needed matters" in Italian than in Polish residents. CONCLUSION: Higher activity level was found to be correlated with lower perceived stress, but the causality is unclear. Difference in adherence to restrictions between Polish and Italian residents suggests that introducing similar lockdown policies worldwide may not be as beneficial as expected. However, due to the applied method of convenience sampling and uneven study groups, one should be careful with generalizing these results.

Attitudes and Perceptions of Health Protection Measures Against the Spread of COVID-19 in Italy and Poland.

Background: During the first wave of the COVID-19 pandemic (April to May 2020), 6,169 Polish and 939 Italian residents were surveyed with an online questionnaire investigating socio-demographic information and personality traits (first section) as well as attitudes, position, and efficacy perceptions on the impact of lockdown (second section) and various health protection measures enforced (third section). Methods: The "health protection attitude score" (HPAS), an endpoint obtained by pooling up the answers to questions of the third section of the survey tool, was investigated by multiple linear regression models, reporting regression coefficients (RC) with 95% confidence intervals (95% CI). Results: Concerns for business and health due to COVID-19 were associated with a positive attitude toward risk reduction rules. By contrast, male sex, concerns about the reliability of information available online on COVID-19 and its prevention, along with the feeling of not being enough informed on the transmissibility/prevention of SARS-CoV-2 were associated with a negative attitude toward risk mitigation measures. Discussion: A recent literature review identified two social patterns with different features in relation to their attitude toward health protection rules against the spread of COVID-19. Factors positively associated with adherence to public health guidelines were perceived threat of COVID-19, trust in government, female sex, and increasing age. Factors associated with decreased compliance were instead underestimation of the COVID-19 risk, limited knowledge of the pandemic, belief in conspiracy theories, and political conservativism. Very few studies have tested interventions to change attitudes or behaviors. Conclusion: To improve attitude and compliance toward risk reduction norms, a key intervention is fostering education and knowledge on COVID-19 health risk and prevention among the general population. However, information on COVID-19 epidemiology might be user-generated and contaminated by social media, which contributed to creating an infodemic around the disease. To prevent the negative impact of social media and to increase adherence to health protection, stronger content control by providers of social platforms is recommended.

Evaluation of Self-Assessed State of Health and Vitamin D Knowledge in Emirati and International Female Students in United Arab Emirates (UAE).

INTRODUCTION: Globally, vitamin D deficiency is one of the most common deficiencies, affecting nearly half the world's population. The objective of this survey was to assess and compare the knowledge about vitamin D and the perceived state of health in Emirati and international tourist female students in Dubai, United Arab Emirates (UAE). METHODS: This is a cross-sectional study that took place in universities in Dubai, United Arab Emirates. This survey consisted of 17 multiple choice questions and was adapted from a study recently conducted in Poland. The first part of the survey assessed levels of supplementation, diet and UV exposure. Another section evaluated the participants' self-assessed state of health in terms of vitamin D testing, symptoms related to vitamin D deficiency and general welbeing. The collected data were statistically analyzed using SPSS statistics for windows version 26.0 (SPSS Inc., Chicago, IL, United States). Statistical significance was set at P < 0.05. RESULTS: 105 respondents were Emiratis and 65 were international students. The average age was 21, with an average BMI 23.3 kg/m2. Almost one-third of each group reported using Vitamin D supplements once weekly. The vast majority of both groups reported rarely getting tanned. Almost all participants in both groups reported regular consumption of Vitamin D rich foods. In both groups, more than half reported consuming milk and cheese regularly and up to one-third reported consuming fish in a regular manner. Although more than half of the students rated their health as good; more than two-thirds reported experiencing muscle pain; only half reported having their blood Vitamin D levels measured once; half reported experiencing problems with concentration and more than three-quarters reported experiencing bad mood in the past month. The prevalence of these symptoms was almost similar across different categories of vitamin D supplementation, tanning habits, dietary intake, or nationality. No statistically significant differences were noted between the Emirati and International tourist students regarding any of the studied variables. CONCLUSION: Notably, more Emirati students were aware of the association between vitamin D and osteoporosis than International tourist students (40% vs. 21.9%, respectively; p < 0.05). On the other hand, both groups had lower knowledge about the relationship between vitamin D deficiency and depression, Rheumatoid Arthritis and Hypertension, and the optimal vitamin D level; however, no statistically significant differences were noted regarding this knowledge of Emiratis and international students.

Antipsychotic Medication Prescribing Trends in a Pediatric Population in Northern Poland 2008-2012.

OBJECTIVES: In recent years antipsychotics have been increasingly used in the population of children and adolescents. The objective of this article is to profile the use of antipsychotic medications in a pediatric population in Poland based on data from the Pomeranian region (Northern Poland). METHODS: The study was based on National Health Fund data about prescription drug reimbursement between 2008 and 2012. A patient database was created using ID to analyze specific patterns and information about individuals using antipsychotics. Percentage population indicators were calculated using official demographic reports. RESULTS: An increased number of overall prescriptions was observed since 2008, with a subsequent decline to its lowest number in 2012. The population with at least one antipsychotic-filled prescription per year has grown in the same time. The annual rate has increased from 0.26% to 0.31% of the general population between 0 and 17 years of age in the Pomeranian region. We observed an increasing number of females and the 0- to 4-year-old receiving antipsychotic prescriptions. The population share of prescribed first-generation antipsychotics exceeded the share of second-generation antipsychotics (SGAs). The use of SGAs increased from 38% to 44% of all prescriptions, during the observation period. The most frequently prescribed drugs were Risperidone (26.7%) and Chlorprothixene (21.7%). CONCLUSIONS: The study revealed that the prescribing patterns of antipsychotics increased in the Polish pediatric population and concerned more patients from the youngest group. The high prevalence of such early exposure to antipsychotics should focus more attention on drug safety in this population.

Towards a new treatment paradigm for ruptured blood blister-like aneurysms of the internal carotid artery? A rapid systematic review.

BACKGROUND AND PURPOSE: Owing to their peculiar features and rare occurrence, ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery are challenging by both surgical and endovascular approaches and their proper management is uncertain. We therefore aimed to define the currently optimal treatment of ruptured BBAs in terms of mortality, outcome, rebleeding, and recurrence. METHOD: An in-depth search of electronic databases, gray literature and internet resources for ruptured BBAs was performed and complemented by data retrieval during neurosurgical congresses. Clinical and radiological characteristics, intervention details, outcomes, and the impact factor of the source journal were pooled. RESULTS: The pooled cohort comprised 311 patients. Neither surgical nor endovascular methods had an impact on clinical outcome, aneurysm regrowth, remote bleeding, or complication rate. By contrast, aneurysm clipping was a predictor of intraoperative bleeding (OR 6.5; 95% CI 1.2 to 34.3), and stent-assisted coiling increased the likelihood of a second treatment (OR 4.1; 95% CI 1.3 to 13.1), its conversion to another modality (OR 4.7; 95% CI 1.4 to 16.0), and incomplete aneurysm obliteration (OR 2.6; 95% CI 1.0 to 6.6). Higher impact journals were more likely to publish papers on endovascular techniques, particularly flow-diverter stents. CONCLUSIONS: None of the methods is unequivocally superior. Considering its inefficiency, stent-assisted coiling should be undertaken with caution. A time-delimited systematic review is needed to establish the most accurate treatment for ruptured BBAs.

Spinal Cord Stimulation in Failed Back Surgery Syndrome: Review of Clinical Use, Quality of Life and Cost-Effectiveness.

Failed back surgery syndrome (FBSS) is complex and recurrent chronic pain after spinal surgery. Several important patient and surgery related risk factors play roles in development of FBSS. Inadequate selection of the candidates for the spinal surgeries is one of the most crucial causes. The guidelines suggest that conservative management featuring pharmacologic approaches and rehabilitation should be introduced first. For therapy-refractory FBSS, spinal cord stimulation (SCS) is recommended in selected patients. Treatment efficacy for FBSS has increased over the years with the majority of patients experiencing pain relief and reduced medicinal load. Improved quality of life can also be achieved using SCS. Cost-effectiveness of SCS still remains unclear. However evidence for SCS role in FBSS is controversial, SCS can be beneficial for carefully classified patients.