OBJECTIVE: To conduct a systematic literature review of spinal cord stimulation (SCS) for pain.
DESIGN: Grade the evidence for SCS.
METHODS: An international, interdisciplinary work group conducted literature searches, reviewed abstracts, and selected studies for grading. Inclusion/exclusion criteria included randomized controlled trials (RCTs) of patients with intractable pain of greater than one year's duration. Full studies were graded by two independent reviewers. Excluded studies were retrospective, had small numbers of subjects, or existed only as abstracts. Studies were graded using the modified Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria.
RESULTS: SCS has Level 1 evidence (strong) for axial back/lumbar radiculopathy or neuralgia (five high-quality RCTs) and complex regional pain syndrome (one high-quality RCT).
CONCLUSIONS: High-level evidence supports SCS for treating chronic pain and complex regional pain syndrome. For patients with failed back surgery syndrome, SCS was more effective than reoperation or medical management. New stimulation waveforms and frequencies may provide a greater likelihood of pain relief compared with conventional SCS for patients with axial back pain, with or without radicular pain.
Patients are likely to ask their primary care clinicians about SCS for their chronic pain. This systematic review provides potentially useful information. My one concern is the large number of industry conflicts reported by many of the authors.
There are many disclosure for the authors with potential for bias and conflict, 'caveat emptor.'
Interesting paper. However because of the methodological problems of the work, the value of work is limited.
This is a very well conducted and written systematic review manuscript.
Findings of some systematic reviews, especially the ones involving small sample trials, may be later contradicted by large trials. It is sad the review is not accompanied by a meta-analysis, even though statistics involving QoL are hard ones in this setting. In a review citation bias results in quoting negative studies less frequently than positive ones, and meta-analysis funnel plot might find bias on such reviews. The size of the listing of disclosure and conflict of interest of the review is also impressive, with many authors with “minor”equities (in as manys as 6 companies). Lastly, the last sentence of the conclusions is not usual in this type o article.
Any review with this amount of support from physicians is very important. Far too many back pain injuries and failed operations plague patients. In the central interior of British Columbia, back pain is considerable and advantage must be taken of services that assist patients with any real consistent relief. More such places of treatment are dearly needed. Referral to pain center for my husband was over a year waiting to find out there may be another form of treatment to try. Any such attempt for treatment is valuable here. More treatment options should be explored and supported. 19% or more in Canada are chronic back pain patients. This number merits more research, applicable treatment options, and less waiting time before they are tried.