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

Charles A Odonkor; Sebastian Orman; Vwaire Orhurhu; Martha E Stone; Shihab Ahmed

doi:10.1093/pm/pnz185

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 Dec 1;20(12):2479-2494. doi: 10.1093/pm/pnz185.

Authors

Charles A Odonkor¹, Sebastian Orman², Vwaire Orhurhu³, Martha E Stone⁴, Shihab Ahmed¹

Affiliations

¹ Division of Pain, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
² Department of Orthopaedics, Georgetown University School of Medicine, Washington, DC.
³ Department of Anesthesiology, Critical Care and Pain, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
⁴ Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts, USA.

PMID: 31498396
DOI: 10.1093/pm/pnz185

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.

Keywords: Chronic Low Back Pain; Conventional Medical Management; Health Care Costs; Leg Pain; Resource Utilization; Spinal Cord Stimulation.

Publication types

Comparative Study
Systematic Review

MeSH terms

Analgesics / therapeutic use
Analgesics, Opioid / therapeutic use
Chronic Pain / economics
Chronic Pain / therapy*
Costs and Cost Analysis
Health Expenditures / statistics & numerical data*
Health Resources / economics
Health Resources / statistics & numerical data*
Humans
Implantable Neurostimulators
Leg
Low Back Pain / economics
Low Back Pain / therapy*
Neurosurgical Procedures
Patient Readmission / economics
Patient Readmission / statistics & numerical data
Physical Therapy Modalities / economics
Prosthesis Implantation
Quality of Life
Quality-Adjusted Life Years
Spinal Cord Stimulation*

Substances

Analgesics
Analgesics, Opioid