Another great 2013 NANS meeting presentation was by Dr. Elliott Krames on Using the S.A.F.E. Principles for Patient Selection and IT Trialing Methods. Initially, Dr. Krames produced a set of guidelines for treating patients with chronic pain, known as KISS; Keep It Simple and Safe. Using the KISS guidelines, he developed an algorithm for treating patients beginning with the simplest and least invasive methods and working his way through to more complex treatments. The essence of the KISS method, according to Dr. Krames, was to establish effective treatment of chronic pain through trial and error.
The fallacy with these guidelines, however, was that efforts with all less invasive treatment methods must be exhausted before moving onto a more interventional approach. With time, Dr. Krames discovered more considerations to be employed in his algorithm. These more contemporary guidelines accept the notion that some treatments are not only more appropriate than others, but also safer, more effective and more financially feasible despite their greater degree of invasiveness. This eventually led him to develop the S.A.F.E. Principles; S – Safety, A – Appropriateness; F – Fiscal neutrality; a very interesting point to consider; E – Effectiveness.
In his article, he quotes Peter Drucker, legendary management consultant, educator, and author, “Efficiency is doing things right; effectiveness is doing the right things”. He emphasized that treatment should be constructed upon a best-overall basis. I highly recommend that all clinicians involved with interventional pain management read Dr. Krames’ article found in the Journal of Neuromodulation.