The Effectiveness of Spinal Cord Stimulation for the Treatment of Axial Low Back Pain: A Systematic Review with Narrative Synthesis
| Autor: | Hank Shipman, Ligia V. Onofrei, Cole W Cheney, Zachary L McCormick, Daniel M. Cushman, Taylor M Burnham, Masaru Teramoto, Beau P. Sperry, Graham E. Wagner, Aaron Conger, Mark A. Mahan |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Visual Analog Scale Visual analogue scale MEDLINE medicine Humans Prospective cohort study Aged Pain Measurement Spinal Cord Stimulation business.industry General Medicine Low back pain Confidence interval Lower limb pain Study heterogeneity Treatment Outcome Anesthesiology and Pain Medicine Spinal Cord Concomitant Physical therapy Neurology (clinical) Chronic Pain medicine.symptom business Low Back Pain |
| Zdroj: | Pain Medicine. 21:2699-2712 |
| ISSN: | 1526-4637 1526-2375 |
| DOI: | 10.1093/pm/pnaa142 |
| Popis: | ObjectiveDetermine the effectiveness of spinal cord stimulation (SCS) for the treatment of axial low back pain (LBP) with or without leg pain.DesignSystematic review.SubjectsPersons aged ≥18 with axial LBP with or without accompanying leg pain.InterventionTraditional low-frequency, burst, or high-frequency SCS.ComparisonSham, active standard of care treatment, or none.OutcomesThe primary outcome was ≥50% pain improvement, and the secondary outcome was functional improvement measured six or more months after treatment intervention.MethodsPublications in PubMed, MEDLINE, and Cochrane databases were reviewed through September 19, 2019. Randomized or nonrandomized comparative studies and nonrandomized studies without internal controls were included. The Cochrane Risk of Bias Tool and GRADE system were used to assess individual study characteristics and overall quality.ResultsQuery identified 262 publications; 17 were suitable for inclusion. For high-frequency SCS, the only level 1 study showed that 79% (95% confidence interval = 70–87%) of patients reported ≥50% pain improvement. For low-frequency SCS, the only level 1 study reported no categorical data for axial LBP-specific outcomes; axial LBP improved by a mean 14 mm on the visual analog scale at six months. Meta-analysis was not performed due to study heterogeneity.ConclusionsAccording to GRADE, there is low-quality evidence that high-frequency SCS compared with low-frequency SCS is effective in patients with axial LBP with concomitant leg pain. There is very low-quality evidence for low-frequency SCS for the treatment of axial LBP in patients with concomitant leg pain. There is insufficient evidence addressing the effectiveness of burst SCS to apply a GRADE rating. |
| Databáze: | OpenAIRE |
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