Abstract
Objective
To synthesize the evidence regarding the effect of spinal stimulation (SS) vs medical
therapy (MT) and the effect of newer SS technologies vs conventional SS on pain reduction
in patients with intractable spine or limb pain.
Methods
A comprehensive literature search was conducted by a reference librarian. The literature
search encompassed January 1, 1995 – December 31, 2017. Reviewers worked independently
to select and appraise trials. Random-effect meta-analysis and frequentist indirect
comparison methods were used to compare the three interventions. Results were expressed
as odds ratio (OR) or weighted mean difference (WMD) with 95% CIs.
Results
We identified 12 trials enrolling 980 patients. Compared with MT, SS significantly
increased the odds of reducing pain by 50% or more in three trials (OR, 13.01; 95%
CI, 4.96-34.17) and significantly reduced pain as measured by visual analogue scale
scores in three trials (WMD, 1.43 scale points; 95% CI, 0.16-2.71). Using the common
comparator of MT, newer stimulation technology (eg, high-frequency 10 kilohertz spinal
stimulation, Burst, dorsal root ganglion) was associated with increased odds of pain
relief compared with conventional SS (OR, 2.07; 95% CI, 1.35-3.19).
Conclusions
In patients with intractable spine/limb pain, SS was associated with better pain reduction
than MT. New stimulation technology was likely associated with better pain reduction
than conventional stimulation.
Abbreviations and Acronyms:
CRPS (complex regional pain syndrome), DRG (dorsal root ganglion), FBSS (failed back surgery syndrome), HF10 (high-frequency 10 kilohertz spinal stimulation), MT (medical therapy), NRS (numeric pain rating scale), OR (odds ratio), RCT (randomized controlled trial), SCS (spinal cord stimulation), SS (spinal stimulation), VAS (visual analogue scale), WMD (weighted mean difference)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 03, 2019
Footnotes
Support was provided solely from institutional sources.
Potential Competing Interests: Tim J. Lamer, MD, was involved in research funded by Boston Scientific and Medtronic. All funds were paid to his institution. The other authors report no competing interests.
Prior Presentations: Abstract accepted for and presented at the American Academy of Pain Medicine Annual Meeting, April 26-29, 2018, Vancouver, British Columbia, Canada.
Identification
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© 2019 Mayo Foundation for Medical Education and Research
