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Vuka I, Marcius T, Dosenovic S, et al. Neuromodulation with electrical field stimulation of dorsal root ganglion in various pain syndromes: a systematic review with focus on participant selection. J Pain Res. 2019 Feb 27;12:803-830. doi: 10.2147/JPR.S168814. eCollection 2019. (Systematic review)
Abstract

Objective: We conducted a systematic review about patient selection, efficacy, and safety of neuromodulation with electrical field stimulation (EFS) of dorsal root ganglion (DRG) in various painful conditions. We also analyzed conclusion statements as well as conflict of interest and financing of the included studies.

Methods: All study designs were eligible for inclusion. We searched MEDLINE, CINAHL, Embase, PsycINFO, and clinical trial registries until September 7, 2018. We assessed risk of bias by using Cochrane tool for randomized controlled trials (RCTs).

Results: Among the 29 included studies, only one was RCT, majority being case series and case reports. The evidence is based on studies with small number of participants (median: 6, range 1-152) with various painful conditions. Neuromodulation with EFS of DRG was mostly performed in participants who have failed other treatment modalities. Most of the authors of the included studies reported positive, but inconclusive, evidence regarding efficacy of neuro-modulation with EFS of DRG. Meta-analysis was not possible since only one RCT was included.

Conclusion: Available evidence suggest that neuromodulation with EFS of DRG may help highly selected participants with various pain syndromes, who have failed to achieve adequate pain relief with other pharmacological and nonpharmacological interventions. However, these findings should be confirmed in high-quality RCTs with sufficient numbers of participants.

Ratings
Discipline Area Score
Physician 4 / 7
Comments from MORE raters

Physician rater

This study was a review of the literature on using electrical field stimulation for treatment of resistant pain syndromes, and the bottom line is that their review revealed only one RCT. This RCT was not blinded. I think that the message here is that this approach appears not to be malpractice, but does not have good evidence arguing for its value.

Physician rater

This might be helpful in primary care as our chronic pain patients keep searching for some of other treatment, given most of what we have works poorly. The above treatment might help some highly selected patients, but the data are s generally not good, so far.

Physician rater

This systematic review of electrical field stimulation of dorsal root ganglia in patients with a range of pain syndromes retrieved 29 relevant publications, only one of which was a RCT with the rest being case reports or cohort studies. Most of the patients had already failed to respond to a range of treatments. It was not possible to do a meta-analysis. While most of the reports were positive the results were generally inconclusive. It is strange that this review was even published given the lack of published evidence to support such a review and the inability of this systematic review to provide any useful conclusions to clinicians managing such patients.
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