Establishing Minimal Clinically Important Difference of Spinal Cord Stimulation Therapy in Post-Laminectomy Syndrome

Paúl, Alexandra; Kumar, Vignessh; Roth, Steven G.; Gooch, M. Reid; Pilitsis, Julie G.

doi:10.1093/neuros/nyx153

Cited by 33 publications

(38 citation statements)

References 18 publications

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“…The pooled analysis showed that the average pooled pain score with tonic SCS was 49.2, whereas with burst SCS it was 36.7, a 12.5-point difference. This is likely to be experienced by the subjects as a clinically important difference, given that the minimal clinically important difference (MCID) for multidisciplinary pain treatment for low back pain was 1 point on a 0–10 NRS [40] and the MCID for SCS treatment of postlaminectomy syndrome was 1–1.2 cm on a 10-cm VAS [41]. The clinical importance of the incremental benefit of burst was supported by the large majority of subjects who preferred burst SCS over tonic.…”

Section: Discussionmentioning

confidence: 99%

Burst Spinal Cord Stimulation: A Systematic Review and Pooled Analysis of Real-World Evidence and Outcomes Data

Chakravarthy

Malayil²,

Kirketeig

et al. 2019

Pain Medicine

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Objective This review provides a comprehensive assessment of the effectiveness of burst spinal cord stimulation (SCS). Ratings of pain intensity (visual analog scale or numeric rating scale) and patient-reported outcomes (PROs) on functional/psychometric domains such as depression (Beck Depression Index), catastrophizing (Pain Catastrophizing Scale), surveillance (Pain Vigilance and Attention Questionnaire), and others are addressed. Design Articles were identified and selected from the literature according to prospective, replicable methods. Effectiveness data—pain scores and PRO ratings—were weighted by study sample sizes and pooled. The effects of burst SCS were compared against values at baseline and with tonic SCS. For PROs, published population norms were used for comparison. Results Fifteen articles, with a combined sample size of 427, were included. Follow-up ranged from a few hours to two years. A variety of prospective designs were employed, including crossover studies, single-arm cohorts, and a randomized controlled trial, as well as retrospective case reports. The weighted pooled mean pain rating across articles at baseline was 76.7 (±27.4). With tonic SCS, this was reduced to 49.2 (±12.9), and with burst SCS it was further reduced to 36.7 (±11.6), a 12.5-point difference between tonic and burst values. Psychometric analyses of PROs noted preferential improvement with burst SCS. In addition, 65% of subjects stated a preference for burst SCS. Conclusions In pooled analyses that incorporated all available published evidence, the improvement over baseline for burst SCS was shown to have a clinically important incremental benefit over tonic SCS. In addition, burst SCS may support resolution of the emotional or cognitive aspects of pain that are mediated by medial thalamo-cortical pathways. This study highlights the value in considering the entire knowledge base in therapeutic assessments as well as adopting a consistent set of outcome variables within neuromodulation. Burst SCS is a valuable intervention, providing both analgesia and psychometric benefits that warrant further thoughtful applications.

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Section: Discussionmentioning

confidence: 99%

Burst Spinal Cord Stimulation: A Systematic Review and Pooled Analysis of Real-World Evidence and Outcomes Data

Chakravarthy

Malayil²,

Kirketeig

et al. 2019

Pain Medicine

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show abstract

“…Thus, the use of the PETSCSC may significantly improve holistic care of SCS patients. Additionally, improvement of patient selection tools may help eliminate the patients in our cohort who, at latest follow‐up, would not repeat surgery and thus limit healthcare expenditures .…”

Section: Discussionmentioning

confidence: 99%

Use of a Psychological Evaluation Tool as a Predictor of Spinal Cord Stimulation Outcomes

Prabhala

Kumar

Gruenthal

et al. 2019

Neuromodulation: Technology at the Neural Interface

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“…This degree of pain relief is in line with other reports of the effectiveness of DRG stimulation . It is likely that this degree of pain relief was interpreted by patients as a significant improvement, as it greatly exceeds the minimal clinically important difference for pain ratings .…”

Section: Discussionmentioning

confidence: 99%

Dorsal Root Ganglion Stimulation Is Paresthesia-Independent: A Retrospective Study

Verrills

Mitchell

Vivian

et al. 2019

Neuromodulation: Technology at the Neural Interface

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Establishing Minimal Clinically Important Difference of Spinal Cord Stimulation Therapy in Post-Laminectomy Syndrome

Cited by 33 publications

References 18 publications

Burst Spinal Cord Stimulation: A Systematic Review and Pooled Analysis of Real-World Evidence and Outcomes Data

Burst Spinal Cord Stimulation: A Systematic Review and Pooled Analysis of Real-World Evidence and Outcomes Data

Use of a Psychological Evaluation Tool as a Predictor of Spinal Cord Stimulation Outcomes

Dorsal Root Ganglion Stimulation Is Paresthesia-Independent: A Retrospective Study

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