Age as an Independent Predictor of Adult Spinal Cord Stimulation Pain Outcomes

Bondoc, Melanie; Hancu, Maria; DiMarzio, Marisa; Sheldon, Breanna L; Shao, Miriam M; Khazen, Olga; Pilitsis, Julie G.

doi:10.1159/000517426

Cited by 6 publications

(6 citation statements)

References 41 publications

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“…Figure 1 depicts the PRISMA flow chart of the study selection and inclusion process. A total of 36 studies met the inclusion criteria and were included for the qualitative analysis 22 40–74 Table 1. describes the characteristics of the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…describes the characteristics of the included studies. There were 7 included RCTs,22 40 50 55 61 63 69 17 prospective studies,41–44 46 47 51 56 59 60 62 64 65 68 70–72 11 retrospective studies,45 48 49 52–54 57 58 66 67 73 and 1 ambispective observational study 74. Thirteen studies were conducted in multiple centers 41–43 46 51 55 56 61 63 68 69 72–74.…”

Section: Resultsmentioning

confidence: 99%

“…The duration of follow-up for physical function outcomes varied from 1 month to 5 years. Twenty-two articles were included in the quantitative analysis and were meta-analyzed 22 40–42 44–48 50 51 55–57 60 63 65–67 69 73 74. Five studies40 48 50 67 73 had multiple study arms where the groups were analyzed and presented separately in the forest plot.…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies40 42 45 46 48 50 56 57 73 74 with 852 patients (at baseline) reported ODI scores at 12 months. Pooled results revealed that ODI scores improved significantly from baseline to 12 months with a mean difference of −17.00% (95% CI −23.07 to −10.94, p<0.001; 852 patients in 10 studies40 42 45 46 48 50 56 57 73 74, figure 3). This finding had high statistical heterogeneity (χ 2 =294.04, df=13 (p<0.001), I 2 =96%).…”

Section: Resultsmentioning

confidence: 99%

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Physical functioning following spinal cord stimulation: a systematic review and meta-analysis

ElSaban

Kleppel

Kubrova

et al. 2023

Reg Anesth Pain Med

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BackgroundSpinal cord stimulation (SCS) has emerged as an important treatment for chronic pain disorders. While there is evidence supporting improvement in pain intensity with SCS therapy, efforts to synthesize the evidence on physical functioning are lacking.ObjectiveThe primary objective of this meta-analysis was to assess long-term physical function following 12 months of SCS for chronic back pain.Evidence reviewPubMed, EMBASE, Scopus, and CENTRAL databases were searched for original peer-reviewed publications investigating physical function following SCS. The primary outcome was physical function at 12 months following SCS therapy for chronic back pain compared with baseline. A random effects model with an inverse variable method was used. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to determine the certainty of evidence.FindingsA total of 518 studies were screened, of which 36 were included. Twenty-two studies were pooled in the meta-analysis. There was a significant reduction in Oswestry Disability Index (ODI) scores at all time frames up to 24 months following implantation. Pooled results revealed significant improvement in ODI scores at 12 months with a mean difference of −17.00% (95% CI −23.07 to −10.94, p<0.001). There was a very low certainty of evidence in this finding as per the GRADE framework. There was no significant difference in subgroup analyses based on study design (randomised controlled trials (RCTs) vs non-RCTs), study funding, or stimulation type.ConclusionThis meta-analysis highlights significant improvements in physical function after SCS therapy. However, this finding was limited by a very low GRADE certainty of evidence and high heterogeneity.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Physical functioning following spinal cord stimulation: a systematic review and meta-analysis

ElSaban

Kleppel

Kubrova

et al. 2023

Reg Anesth Pain Med

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“…Relatively few studies have explored the differences in long-term outcomes based on patient’s age, sex or gender. Retrospective observational studies indicate that younger age is associated with increased conversion to full implant25 and increased age was a predictor of higher explantation risk,33 although a recent small study found no difference in pain scores with age 67. Women have been noted to have a higher rate of explantation, mostly because of device-related discomfort,68 and men with refractory angina pectoris who are treated with SCS have been noted to have a larger improvement in quality of life compared with women with SCS for refractory angina 34.…”

Section: Committee Statements and Recommendationsmentioning

confidence: 99%

Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain

Shanthanna

Eldabe

Provenzano³

et al. 2023

Reg Anesth Pain Med

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Spinal cord stimulation (SCS) has demonstrated effectiveness for neuropathic pain. Unfortunately, some patients report inadequate long-term pain relief. Patient selection is emphasized for this therapy; however, the prognostic capabilities and deployment strategies of existing selection techniques, including an SCS trial, have been questioned. After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, a steering committee was formed to develop evidence-based guidelines for patient selection and the role of an SCS trial. Representatives of professional organizations with clinical expertize were invited to participate as committee members. A comprehensive literature review was carried out by the steering committee, and the results organized into narrative reports, which were circulated to all the committee members. Individual statements and recommendations within each of seven sections were formulated by the steering committee and circulated to members for voting. We used a modified Delphi method wherein drafts were circulated to each member in a blinded fashion for voting. Comments were incorporated in the subsequent revisions, which were recirculated for voting to achieve consensus. Seven sections with a total of 39 recommendations were approved with 100% consensus from all the members. Sections included definitions and terminology of SCS trial; benefits of SCS trial; screening for psychosocial characteristics; patient perceptions on SCS therapy and the use of trial; other patient predictors of SCS therapy; conduct of SCS trials; and evaluation of SCS trials including minimum criteria for success. Recommendations included that SCS trial should be performed before a definitive SCS implant except in anginal pain (grade B). All patients must be screened with an objective validated instrument for psychosocial factors, and this must include depression (grade B). Despite some limitations, a trial helps patient selection and provides patients with an opportunity to experience the therapy. These recommendations are expected to guide practicing physicians and other stakeholders and should not be mistaken as practice standards. Physicians should continue to make their best judgment based on individual patient considerations and preferences.

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The Association of Psychiatric Comorbidities With Short-Term and Long-Term Outcomes Following Spinal Cord Stimulator Placement

Beletsky

Alexander

Hassanin

et al. 2023

Neuromodulation: Technology at the Neural Interface

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Age as an Independent Predictor of Adult Spinal Cord Stimulation Pain Outcomes

Cited by 6 publications

References 41 publications

Physical functioning following spinal cord stimulation: a systematic review and meta-analysis

Physical functioning following spinal cord stimulation: a systematic review and meta-analysis

Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain

The Association of Psychiatric Comorbidities With Short-Term and Long-Term Outcomes Following Spinal Cord Stimulator Placement

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