The impact of spinal cord stimulation on physical function and sleep quality in individuals with failed back surgery syndrome: A systematic review

Abstract

The aim of this review was to determine the impact of spinal cord stimulation (SCS) on physical function and sleep quality in individuals with failed back surgery syndrome (FBSS). This review comprised three phases: an electronic database search (PubMed, Cinahl Plus, EMBASE, PsychInfo, Pedro, Cochrane Library) identified potential papers; these were screened for inclusion criteria, with extraction of data from accepted papers and rating of internal validity by two independent reviewers using the Effective Public Health Practice Project quality assessment tool, a tool designed to assess non-RCTs (randomized controlled trials) as well as RCTs. Strength of the evidence was rated using the Agency for Health Care Policy and Research guidelines. The search generated 13 quantitative papers that fulfilled the inclusion criteria; all 13 studies investigated the impact of SCS on physical function, and nine studies investigated the impact of SCS on sleep quality. Consistent evidence (level C) found that SCS positively affected physical function, with improvements in participation in activities of daily living, leisure, social and work-related activities. Similarly, consistent evidence (level C) found improvements in sleep quality following SCS. Improvements in sleep quantity, a reduction in awakenings and a decrease in sleep medication use were also noted (level D). The impact of SCS on cognitive function, i.e., memory and concentration, was also assessed using the same search strategy, no papers fulfilled the inclusion criteria for this study. Spinal cord stimulation effectively addressed many physical function and sleep problems associated with FBSS; however, there is a need for further high-quality objective investigations to support this.

Patients’ Expectations on Spinal Cord Stimulation for Failed Back Surgery Syndrome: A Qualitative Exploration

“…All patients who reported having trouble sleeping expected that SCS would improve their sleep. It has been reported before that SCS positively affects sleep quality . Interestingly, none of the patients mentioned expectations with regard to sexual relationships.…”

“…Although a review showed little evidence of SCS improving daily activities in humans, it has been reported that SCS restored daily physical activity in animals . The effect of SCS on daily activities is therefore a secondary objective, whereas pain relief forms the primary objective in clinical research .…”

Spinal Cord Stimulation Ameliorates Neuropathic Pain-Related Sleep Disorders: A Case Series

“…Moreover, this reciprocal influence of pain and sleep results in the deterioration of QOL . There is supporting evidence from several studies that SCS not only alleviates pain but also improves sleep problems and patient QOL .…”

“…Furthermore, in most studies of sleep disorders in patients with chronic pain, the evaluation of sleep disturbance has been based solely on patient reports or responses to questionnaires. Among nonpharmacological treatments, spinal cord stimulation (SCS) has been reported to effectively improve sleep disorders as well as pain, although the reports were subjective self‐reports . Because the subjective sleep complaints of patients are not always associated with actual sleep impairment , there is a need for further objective investigations to support the impact of SCS on sleep disorders.…”

Spinal Cord Stimulation in Failed Back Surgery Syndrome: Review of Clinical Use, Quality of Life and Cost-Effectiveness

“…Many studies showed statistically significant difference, measured in psycho-sociological questionnaires, between baseline and follow-up [5455]. A systematic review of 13 studies reported improvement in physical function as measured by the Sickness Impact Profil, disability measured by the Oswestry disability index (ODI), activities of daily living, participation in leisure, social, and work-related activities [56]. Several other studies did not show statistically significant improved ability to participate in social activities and pursue hobbies [505758].…”