Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial

Deer, Timothy R.; Levy, Robert M.; Kramer, Jeffery M.; Poree, Lawrence; Amirdelfan, Kasra; Grigsby, Eric; Staats, Peter S.; Burton, Allen W.; Burgher, Abram H.; Obray, Jon B.; Scowcroft, James; Golovac, Stan; Kapural, Leonardo; Paicius, Richard; Kim, Christopher; Pope, Jason E.; Yearwood, Thomas; Samuel, S.; McRoberts, W. Porter; Cassim, Hazmer; Netherton, Mark D.; Miller, Nathan; Schaufele, Michael K.; Tavel, Edward; Davis, Timothy T.; Davis, Kristina; Johnson, Linda; Mekhail, Nagy

doi:10.1097/j.pain.0000000000000814

Cited by 506 publications

(539 citation statements)

References 26 publications

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“…[46][47][48] One RCT described SCS outcomes for CRPS with the use of a traditional percutaneous system compared with a non-SCS control (1 RCT with 2 additional articles describing 2-and 5-year follow-up data [49][50][51], and an additional RCT (ACCURATE Study ClinicalTrials.gov identifier: NCT01923285) described data comparing DRG stimulation to traditional SCS for the treatment of lower-extremity CRPS. 52 Two RCTs addressed SCS outcomes for PDN 53,54 (with 1 additional article reporting 2-year follow-up data 55 ).…”

Section: Resultsmentioning

confidence: 99%

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Spinal Cord Stimulation 50 Years Later

Mekhail

Visnjevac

Azer

et al. 2018

Regional Anesthesia and Pain Medicine

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To assess the efficacy of spinal cord stimulation (SCS) for each indication, one must critically assess each specific clinical outcome to identify outcomes that benefit from SCS therapy. To date, a comprehensive review of clinically relevant outcome-specific evidence regarding SCS has not been published. We aimed to assess all randomized controlled trials from the world literature for the purpose of evaluating the clinical outcome-specific efficacy of SCS for the following outcomes: perceived pain relief or change pain score, quality of life, functional status, psychological impact, analgesic medication utilization, patient satisfaction, and health care cost and utilization. Interventions were SCS, without limitation to the type of controls or the type of SCS in the active arms. For each study analyzed, a quality assessment was performed using a validated scale that assesses reporting, external validity, bias, confounding, and power. Each outcome was assessed specific to its indication, and the primary measure of each abovementioned outcome was a summary of the level of evidence. Twenty-one randomized controlled trials were analyzed (7 for trunk and limb pain, inclusive of failed back surgery syndrome; 8 for refractory angina pectoris; 1 for cardiac X syndrome; 3 for critical limb ischemia; 2 for complex regional pain syndrome; and 2 for painful diabetic neuropathy). Evidence assessments for each outcome for each indication were depicted in tabular format. Outcome-specific evidence scores were established for each of the abovementioned indications, providing both physicians and patients with a summary of evidence to assist in choosing the optimal evidence-based intervention. The evidence presented herein has broad applicability as it encompasses a breadth of patient populations, variations of SCS therapy, and comparable controls that, together, reflect comprehensive clinical decision making.

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Section: Resultsmentioning

confidence: 99%

“…49,52 As the controls and active arms differ dramatically in these 2 studies, the resultant heterogeneity precludes amalgamation of data for a composite assessment of evidence. Thus, evidence scores for CRPS outcomes are individually represented in Table 6.…”

Section: Neuropathic Pain (Crps and Pdn)mentioning

confidence: 99%

Spinal Cord Stimulation 50 Years Later

Mekhail

Visnjevac

Azer

et al. 2018

Regional Anesthesia and Pain Medicine

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“…32 With DRG stimulation, 74.2% of patients had over 50% pain reduction at 12 months, compared with only 53% of those with traditional tonic stimulation. 32 The FDA has approved the use of DRG stimulation for the treatment of lower-limb CRPS.…”

Section: Dorsal Root Ganglion Stimulationmentioning

confidence: 99%

“…31 The ACCURATE trial was the largest randomised controlled trial to compare DRG stimulation against traditional tonic SCS. 32 In 152 patients who had CRPS and/or peripheral causalgia of the lower limbs for over 6 months, DRG stimulation resulted in better pain control at 3 and 12 months, greater improvement in quality of life, better functional status, and better psychological well-being. 32 With DRG stimulation, 74.2% of patients had over 50% pain reduction at 12 months, compared with only 53% of those with traditional tonic stimulation.…”

Section: Dorsal Root Ganglion Stimulationmentioning

confidence: 99%

“…32 In 152 patients who had CRPS and/or peripheral causalgia of the lower limbs for over 6 months, DRG stimulation resulted in better pain control at 3 and 12 months, greater improvement in quality of life, better functional status, and better psychological well-being. 32 With DRG stimulation, 74.2% of patients had over 50% pain reduction at 12 months, compared with only 53% of those with traditional tonic stimulation. 32 The FDA has approved the use of DRG stimulation for the treatment of lower-limb CRPS.…”

Section: Dorsal Root Ganglion Stimulationmentioning

confidence: 99%

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Spinal cord stimulation for chronic non-cancer pain: a review of current evidence and practice

2017

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Spinal Cord Stimulation vs Medical Management for Chronic Back and Leg Pain

Huygen,

Soulanis,

Rtveladze

et al. 2024

JAMA Netw Open

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ImportanceChronic back and lower extremity pain is one of the leading causes of disability worldwide. Spinal cord stimulation (SCS) aims to improve symptoms and quality of life.ObjectiveTo evaluate the efficacy of SCS therapies compared with conventional medical management (CMM).Data SourcesMEDLINE, Embase, and Cochrane Library were systematically searched from inception to September 2, 2022.Study SelectionSelected studies were randomized clinical trials comparing SCS therapies with sham (placebo) and/or CMM or standard treatments for adults with chronic back or leg pain who had not previously used SCS.Data Extraction and SynthesisEvidence synthesis estimated odds ratios (ORs) and mean differences (MDs) and their associated credible intervals (CrI) through bayesian network meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for network meta-analyses was followed.Main Outcomes and MeasuresThe primary outcomes were pain-related end points, including pain intensity (measured by visual analog scale) and proportion of patients achieving at least 50% pain relief (responder rate) in the back or leg. Quality of life (measured by EQ-5D index score) and functional disability (measured by the Oswestry Disability Index score) were also considered.ResultsA total of 13 studies of 1561 patients were included in the network meta-analysis comparing conventional and novel SCS therapies with CMM across the 6 outcomes of interest at the 6-month follow-up. Both conventional and novel SCS therapies were associated with superior efficacy compared with CMM in responder rates in back (conventional SCS: OR, 3.00; 95% CrI, 1.49 to 6.72; novel SCS: OR, 8.76; 95% CrI, 3.84 to 22.31), pain intensity in back (conventional SCS: MD, −1.17; 95% CrI, −1.64 to −0.70; novel SCS: MD, −2.34; 95% CrI, −2.96 to −1.73), pain intensity in leg (conventional SCS: MD, −2.89; 95% CrI, −4.03 to −1.81; novel SCS: MD, −4.01; 95% CrI, −5.31 to −2.75), and EQ-5D index score (conventional SCS: MD, 0.15; 95% CrI, 0.09 to 0.21; novel SCS: MD, 0.17; 95% CrI, 0.13 to 0.21). For functional disability, conventional SCS was superior to CMM (MD, −7.10; 95% CrI, −10.91 to −3.36). No statistically significant differences were observed for other comparisons.Conclusions and RelevanceThis systematic review and network meta-analysis found that SCS therapies for treatment of chronic pain in back and/or lower extremities were associated with greater improvements in pain compared with CMM. These findings highlight the potential of SCS therapies as an effective and valuable option in chronic pain management.

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Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial

Abstract: A comparative effectiveness trial indicates that dorsal root ganglion stimulation provided a higher rate of treatment success with less postural variation in paresthesia intensity compared to spinal cord stimulation.

Cited by 506 publications

References 26 publications

Spinal Cord Stimulation 50 Years Later

Spinal Cord Stimulation 50 Years Later

Spinal cord stimulation for chronic non-cancer pain: a review of current evidence and practice

Spinal Cord Stimulation vs Medical Management for Chronic Back and Leg Pain

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