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Odonkor CA, Orman S, Orhurhu V, et al. Spinal Cord Stimulation vs Conventional Therapies for the Treatment of Chronic Low Back and Leg Pain: A Systematic Review of Health Care Resource Utilization and Outcomes in the Last Decade. Pain Med. 2019 Sep 9. pii: 5566358. doi: 10.1093/pm/pnz185. (Systematic review)
Abstract

OBJECTIVE: The purpose of this review is to critically appraise the literature for evidence supporting the health care resource utilization and cost-effectiveness of spinal cord stimulation (SCS) compared with conventional therapies (CTs) for chronic low back and leg pain.

METHODS: The PubMed, MEDLINE, Embase, CINAHL, and Rehabilitation & Sports Medicine databases were searched for studies published from January 2008 through October 2018, using the following MeSH terms: "spinal cord stimulation," "chronic pain," "back pain," "patient readmission," "economics," and "costs and cost analysis." Additional sources were added based on bibliographies and consultation with experts. The following data were extracted and analyzed: demographic information, study design, objectives, sample sizes, outcome measures, SCS indications, complications, costs, readmissions, and resource utilization data.

RESULTS: Of 204 studies screened, 11 studies met inclusion criteria, representing 31,439 SCS patients and 299,182 CT patients. The mean age was 53.5 years for SCS and 55.6 years for CT. In eight of 11 studies, SCS was associated with favorable outcomes and found to be more cost-effective than CT for chronic low back pain. Compared with CT, SCS resulted in shorter hospital stays and lower complication rates and health care costs at 90 days. SCS was associated with significant improvement in health-related quality of life, health status, and quality-adjusted life-years.

CONCLUSIONS: For the treatment of chronic low back and leg pain, the majority of studies are of fair quality, with level 3 or 4 evidence in support of SCS as potentially more cost-effective than CT, with less resource expenditure but higher complication rates. SCS therapy may yet play a role in mitigating the financial burden associated with chronic low back and leg pain.

Ratings
Discipline Area Score
Physician 5 / 7
Rehab Clinician (OT/PT) 5 / 7
Comments from MORE raters

Physician rater

This is concordant with my own real world experience in this difficult subset of patients. Of the ten or so patients in my primary care practice who have had a spinal cord stimulator placed for chronic back and/orleg pain, none, in my opinion, have had great improvements in their quality of life and several have had complications leading to multiple procedures.

Physician rater

There has been SO MUCH conflict of interest in this field, with some colleagues being under pressure from the manufacturers to support use.

Rehab Clinician (OT/PT) rater

There appears to be lack of adequately controlled high quality studies and this article demonstrated the paucity of the literature, but lacks the detail in explaining the definition of Conventional Therapies.
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