Pain Matters Podcast Network · AAPM - American Academy of Pain Medicine

Setting the Record Straight: A Response to JAMA on Corporate Influences on Spinal Cord Stimulation

·24 min·1 clip

Dr. Schuster says spinal cord stimulation studies need better placebo and sham-controlled trials, but current funding realities limit them.

The episode begins by responding directly to a recent JAMA viewpoint titled Corporate Influences on Science and Health, the Case of Spinal Cord Stimulation. The hosts treat the piece as a challenge to the idea that anyone defending spinal cord stimulation must be serving industry. They argue that the earlier Cochrane Review was methodologically flawed and deserves another look. The conversation then shifts to evidence quality. The hosts acknowledge that stronger placebo- and sham-controlled studies are needed, but point out that these trials are extremely expensive and difficult to run. They also note that government funders usually are not interested in supporting them, especially at the multicenter scale those studies would require. Industry funding comes up next. The episode notes that major journals such as The Lancet and The New England Journal of Medicine publish many industry-funded studies, and that such work can still be well designed. The discussion then connects the issue to the FDA 510(k) pathway. Under that framework, a company may only need to show substantial equivalence to an existing device. The hosts suggest that this shapes the kind of evidence companies are likely to produce, even though they would prefer to see more placebo- and sham-controlled work. The episode ends by pointing listeners toward a future meeting in Scottsdale where the Cochrane Review, its criticisms, and their merit will be discussed. The overall tone stays measured and technical, with more focus on methodological debate than on factional loyalty.

As heard by us

A blunt defense of spinal cord stimulation that centers on evidence standards, trial limits, and device approval realities.

This episode pushes back on the habit of treating evidence criticism and industry funding as the same charge. It argues that spinal cord stimulation deserves tougher placebo and sham controlled studies, while also noting that those trials are costly and hard to run, especially…

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