Are Invasive Procedures Effective for Chronic Pain? A Systematic Review

Jonas, Wayne B.; Crawford, Cindy; Colloca, Luana; Kriston, Levente; Linde, Klaus; Moseley, Bruce; Meißner, Karin

doi:10.1093/pm/pny154

Cited by 28 publications

(19 citation statements)

References 56 publications

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“… 1 , 2 , 3 Effective, long‐term pharmacological, interventional, and surgical treatments remain elusive. 4 Spinal cord stimulation (SCS) is a well‐established treatment for chronic LBP and leg pain (LP). 5 , 6 Traditional SCS provides modest long‐term relief for patients with LBP.…”

Section: Introductionmentioning

confidence: 99%

Twelve‐Month results from multicenter, open‐label, randomized controlled clinical trial comparing differential target multiplexed spinal cord stimulation and traditional spinal cord stimulation in subjects with chronic intractable back pain and leg pain

Fishman

Cordner

Justiz³

et al. 2021

Pain Practice

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Background: Spinal cord stimulation (SCS) is a well-established treatment for chronic intractable pain of the trunk and/or limbs; however, low back pain (LBP) is difficult to treat using traditional SCS. Differential Target Multiplexed spinal cord stimulation (DTM SCS) is an advanced approach inspired from animal studies demonstrating improved pain-related behavior and pain-relevant biological processes. Objective:The purpose of this study was to compare the effectiveness of DTM SCS and traditional SCS in treating chronic LBP and leg pain (LP).Methods: This prospective, postmarket randomized controlled trial compared DTM SCS to traditional SCS in patients with chronic LBP and LP. Primary end point was LBP responder rate (percentage of subjects with ≥ 50% relief) at 3 months. Noninferiority and superiority were assessed. Other outcomes included mean change in back and leg pain, responder rates, disability, global health, satisfaction, and safety profile throughout the 12-month follow-up.Results: One hundred twenty-eight subjects were randomized across 12 centers (67 DTM SCS and 61 traditional SCS). Of the 94 patients implanted, 46 subjects in each group completed the 3-month assessment. LBP responder rate of 80.1% with DTM SCS was superior to 51.2% with traditional SCS (p = 0.0010). Mean LBP reduction (5.36 cm) with DTM SCS was greater than reduction (3.37 cm) with traditional SCS (p < 0.0001). These results were sustained at 6 months and 12 months. Safety profiles were similar between treatment groups. Conclusion:Superiority of DTM SCS compared with traditional SCS for chronic LBP was demonstrated. Clinical improvements provided by DTM SCS were M ET HOD S Study design and patient selectionThis multicenter, prospective, open-label, postmarket RCT was designed to assess DTM SCS as compared with traditional SCS in subjects with intractable LBP and LP. The study was conducted at 12 investigational sites across the United States in compliance with the US Code of Federal Regulations, Good Clinical Practice Guidelines, and the 18th World Medical Assembly of Helsinki. The study protocol and informed consent forms were approved by the Western Institutional Review Board, Puyallup, WA. The study was registered with clinicaltrials.gov (NCT03606187). Key eligibility criteria are listed in Table 1.sustained over 12 months and are expected to significantly impact the management of chronic LBP.

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Section: Introductionmentioning

confidence: 99%

Twelve‐Month results from multicenter, open‐label, randomized controlled clinical trial comparing differential target multiplexed spinal cord stimulation and traditional spinal cord stimulation in subjects with chronic intractable back pain and leg pain

Fishman

Cordner

Justiz³

et al. 2021

Pain Practice

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“…24 A systematic review investigating the use of placebo compared with invasive procedures for chronic pain concluded a higher improvement for placebo over actual treatments. 25 The fact our results are statistically significant suggests our patients do see an improvement. However, to gauge the clinical impact of our results, we aim to add the following questionnaires: PROMIS-29, FSFI, and Absenteeism.…”

Section: Outcome Measurementsmentioning

confidence: 52%

“…Additionally, the reliability of the one‐dimensional VAS pain scale needs to be confirmed as there currently is not a universally agreed on minimum clinically important difference in chronic pain 24 . A systematic review investigating the use of placebo compared with invasive procedures for chronic pain concluded a higher improvement for placebo over actual treatments 25 . The fact our results are statistically significant suggests our patients do see an improvement.…”

Section: Discussionmentioning

confidence: 89%

Neuromuscular treatment approach for women with chronic pelvic pain syndrome improving pelvic pain and functionality

Daniel

Vyas

Tailor

et al. 2021

Neurourology and Urodynamics

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Aims: Reporting the effects of treating underlying myofascial dysfunction and neuropathic pain in women with chronic pelvic pain syndrome (CPPS).Methods: Retrospective longitudinal study of 186 women with CPPS treated with ultrasound-guided peripheral nerve blocks and trigger point injections to pelvic floor muscles alongside pelvic floor physical therapy once weekly for 6 weeks in an outpatient setting. Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS) questionnaires quantified pain and function in the pelvis. Working, intercourse, sleeping, walking, running, lifting, bladder, and bowel were the function categories. Statistical significance was established by p value less than .05 in paired two-sample t-test.Results: VAS improved by 2.14 where average VAS before treatment was 6.61 (standard deviation [SD] 2.45; p < .05, 95% confidence interval [CI] = 6.26-6.96) and average VAS after treatment was 4.47 (SD 2.71; p < .05, 95% CI = 4.08-4.86).

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“…Nevertheless, there is no evidence that use of opioids improves return to work or reduces the need for other treatments (21). In addition, a recent systematic review showed that real surgery is no better than sham surgery for CLBP (38). For these reasons, researchers and clinicians have during the last decade made an effort to change the paradigm of LBP, looking for possible causes and implementing new treatment approaches.…”

Section: A C C E P T E Dmentioning

confidence: 99%

Core Muscle Activity Assessed by Electromyography During Exercises for Chronic Low Back Pain: A Systematic Review

Escriche-Escuder

Calatayud

Aiguadé

et al. 2019

Strength &Amp; Conditioning Journal

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Low back pain (LBP) is one of the most frequent health problems worldwide affecting both work and personal life. While physical exercise focusing on the core muscles is commonly used as part of treatment, there is no systematic overview of exercise specificity and intensity among people with chronic LBP (CLBP). This manuscript aims to systematically review the literature on core muscle activity assessed by electromyography (EMG) during exercises in adults with non-specific CLBP. This systematic review serves as a reference guide in the selection of core muscle exercises for non-specific CLBP.

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Are Invasive Procedures Effective for Chronic Pain? A Systematic Review

Cited by 28 publications

References 56 publications

Twelve‐Month results from multicenter, open‐label, randomized controlled clinical trial comparing differential target multiplexed spinal cord stimulation and traditional spinal cord stimulation in subjects with chronic intractable back pain and leg pain

Twelve‐Month results from multicenter, open‐label, randomized controlled clinical trial comparing differential target multiplexed spinal cord stimulation and traditional spinal cord stimulation in subjects with chronic intractable back pain and leg pain

Neuromuscular treatment approach for women with chronic pelvic pain syndrome improving pelvic pain and functionality

Core Muscle Activity Assessed by Electromyography During Exercises for Chronic Low Back Pain: A Systematic Review

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