TY - JOUR
T1 - Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome
T2 - A systematic review of effectiveness and complications
AU - Turner, Judith A.
AU - Loeser, John D.
AU - Deyo, Richard A.
AU - Sanders, Stacy B.
N1 - Funding Information:
Support for this review was provided by the Medical Aid Fund of the Washington State Department of Labor and Industries. Dr Loeser has received research grant support from, and served as a lecturer and consultant for, Medtronic, Inc. The other authors have no relationship with any spinal cord stimulator manufacturer.
PY - 2004/3
Y1 - 2004/3
N2 - We conducted a systematic review of the literature on the effectiveness of spinal cord stimulation (SCS) in relieving pain and improving functioning for patients with failed back surgery syndrome and complex regional pain syndrome (CRPS). We also reviewed SCS complications. Literature searches yielded 583 articles, of which seven met the inclusion criteria for the review of SCS effectiveness, and 15 others met the criteria only for the review of SCS complications. Two authors independently extracted data from each article, and then resolved discrepancies by discussion. We identified only one randomized trial, which found that physical therapy (PT) plus SCS, compared with PT alone, had a statistically significant but clinically modest effect at 6 and 12 months in relieving pain among patients with CRPS. Similarly, six other studies of much lower methodological quality suggest mild to moderate improvement in pain with SCS. Pain relief with SCS appears to decrease over time. The one randomized trial suggested no benefits of SCS in improving patient functioning. Although life-threatening complications with SCS are rare, other adverse events are frequent. On average, 34% of patients who received a stimulator had an adverse occurrence. We conclude with suggestions for methodologically stronger studies to provide more definitive data regarding the effectiveness of SCS in relieving pain and improving functioning, short- and long-term, among patients with chronic pain syndromes.
AB - We conducted a systematic review of the literature on the effectiveness of spinal cord stimulation (SCS) in relieving pain and improving functioning for patients with failed back surgery syndrome and complex regional pain syndrome (CRPS). We also reviewed SCS complications. Literature searches yielded 583 articles, of which seven met the inclusion criteria for the review of SCS effectiveness, and 15 others met the criteria only for the review of SCS complications. Two authors independently extracted data from each article, and then resolved discrepancies by discussion. We identified only one randomized trial, which found that physical therapy (PT) plus SCS, compared with PT alone, had a statistically significant but clinically modest effect at 6 and 12 months in relieving pain among patients with CRPS. Similarly, six other studies of much lower methodological quality suggest mild to moderate improvement in pain with SCS. Pain relief with SCS appears to decrease over time. The one randomized trial suggested no benefits of SCS in improving patient functioning. Although life-threatening complications with SCS are rare, other adverse events are frequent. On average, 34% of patients who received a stimulator had an adverse occurrence. We conclude with suggestions for methodologically stronger studies to provide more definitive data regarding the effectiveness of SCS in relieving pain and improving functioning, short- and long-term, among patients with chronic pain syndromes.
KW - Complex regional pain syndrome
KW - Failed back surgery syndrome
KW - Spinal cord stimulation
KW - Systematic review
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U2 - 10.1016/j.pain.2003.12.016
DO - 10.1016/j.pain.2003.12.016
M3 - Article
C2 - 15109517
AN - SCOPUS:1342342981
SN - 0304-3959
VL - 108
SP - 137
EP - 147
JO - Pain
JF - Pain
IS - 1-2
ER -