Spinal Cord Stimulation 50 Years Later

Abstract

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.

Real-World Cost-Effectiveness Analysis of Spinal Cord Stimulation vs Conventional Therapy in the Management of Failed Back Surgery Syndrome

“…Spinal cord stimulation (SCS) can be effective at reducing pain and disability while improving Health Related Quality of Life (HRQoL) among FBSS patients. 6 However, SCS is still mostly recommended to FBSS patients only after CMM has failed and when the pain has a neuropathic component. 5 , 7 …”

“…3,5 Spinal cord stimulation (SCS) can be effective at reducing pain and disability while improving Health Related Quality of Life (HRQoL) among FBSS patients. 6 However, SCS is still mostly recommended to FBSS patients only after CMM has failed and when the pain has a neuropathic component. 5,7 Proper clinical management of FBSS should aim not only to alleviate pain, but also to improve physical function and HRQoL and lower drug dependency.…”

A Call to Action Toward Optimizing the Electrical Dose Received by Neural Targets in Spinal Cord Stimulation Therapy for Neuropathic Pain

“…Although used clinically for more than 50 years, SCS has gained a great deal of interest in recent years, as it represents a drug-free option for ongoing management of chronic pain, such as back pain, radicular pain, complex regional pain syndrome (which includes causalgia), peripheral neuropathies, and other neuropathic pain conditions. [5][6][7] Traditionally, for SCS therapy, electrodes are implanted in the epidural space overlying the portions of the dorsal column of the spinal cord that somatotopically correspond to the painful dermatomes of the body. An electrical current is then delivered to the electrodes by means of an implanted pulse generator that often includes an implanted battery.…”

High-frequency 10 kHz Spinal Cord Stimulation for Chronic Back and Leg Pain

“…Spinal cord stimulation (SCS) has been shown to reduce back and leg pain, improve functional capacity and enhance health-related quality of life (HRQoL). 4 , 5 It is recommended in clinical guidelines for both CBLP and FBSS patients when conventional medical management (CMM) fails to control symptoms. 6 – 8 SCS involves the implantation of a stimulation device connected to electrodes placed near the spinal cord.…”