IMPORTANCE: Chronic 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.
OBJECTIVE: To evaluate the efficacy of SCS therapies compared with conventional medical management (CMM).
DATA SOURCES: MEDLINE, Embase, and Cochrane Library were systematically searched from inception to September 2, 2022.
STUDY SELECTION: Selected 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 SYNTHESIS: Evidence 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 MEASURES: The 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.
RESULTS: A 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 RELEVANCE: This 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.
| Discipline Area | Score |
|---|---|
| Physician |  |
| Rehab Clinician (OT/PT) | |
Physician rater
Compared with conventional medical management (drugs, physical therapy, therapeutic exercise, cognitive behavioural therapy, etc), spinal cord stimulation (SCS) has been demonstrated to offer superior efficacy in terms of quality-of-life and functional disability after a six-month follow-up period in patients with chronic back and/or lower limb pain. Rehabilitation professionals consider spinal cord stimulation a potential treatment option for patients who have not responded to conventional therapies. However, a comprehensive assessment is essential to identify individuals who may benefit from SCS. A multidisciplinary approach involving physiatrists, physical therapists, psychologists, and pain specialists may improve treatment outcomes.
Physician rater
Both conventional and novel spinal cord stimulation (SCS) therapies have been demonstrated to be more efficacious than conventional medical management in relieving pain and improving of quality-of-life in patients with chronic back and/or lower limb pain at six months post-treatment. Pain therapy professionals could consider SCS as a potential option for these chronic pain patients who have not achieved satisfactory pain relief through traditional management. Trial procedures should be conducted prior to the permanent implantation of SCS devices. Continuous monitoring of patients following SCS implantation is essential for assessing long-term efficacy and making necessary adjustments to treatment plans.
Physician rater
Excellent study. Hopefully more long-term results will appear in future.
Rehab Clinician (OT/PT) rater
It would be worth considering a repeat of the study not funded by Medtronic.
Rehab Clinician (OT/PT) rater
As a physical therapist, I find the results of the study are not directly related to my practice. The included studies in this systematic review did not compare spinal cord stimulation with physical therapy modalities (e.g., therapeutic exercises or manual therapy).
Dr. Michael Findlay (12/1/2024 6:39 PM)
Unfortunately, this is an industry-funded paper. No effort is made to consider bias, therefore, the outcomes are not valid. This makes no meaningful contribution to the effectiveness of SCS.
, McMaster University