학술논문
Long-term efficacy of spinal cord stimulation for chronic primary neuropathic pain in the contemporary era: a systematic review and meta-analysis.
Document Type
Academic Journal
Author
Fatima K; Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.; Javed SO; Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.; Saleem A; Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.; Marsia S; Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.; Zafar R; Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.; Noorani K; Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.; Kumar S; Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan - sahlish_kumar@icloud.com.; Ali SM; Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.; Ismail I; Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.; Hashim I; Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.; Ganatra FA; Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Source
Publisher: Minerva Medica Country of Publication: Italy NLM ID: 0432557 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1827-1855 (Electronic) Linking ISSN: 03905616 NLM ISO Abbreviation: J Neurosurg Sci Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: Spinal cord stimulation (SCS) is a modern neuromodulation technique extensively proven to be an effective modality for treatment of chronic neuropathic pain. It has been mainly studied for complex regional pain syndrome (CRPS) and failed back surgery syndrome (FBSS) and recent data almost uniformly establishes its statistically significant positive therapeutic results. It has also been compared with other available treatment modalities across various studies. However, long term data on maintenance of its efficacious potential remains less explored. Few studies have reported data on long follow-up times (>= 12 months) and have compared its efficacy with other treatment options for chronic pain, respectively. Our study pools and analyzes the available data and compares SCS with other treatment options. It also analyzes the efficacy of SCS in long term management of patients with chronic pain.
Evidence Acquisition: We reviewed all the data available on MEDLINE, Embase and Cochrane CENTRAL using a search strategy designed to fit our pre-set inclusion and exclusion criteria. Both single-arm and double-arm studies were included. The primary outcome was defined as decrease of visual analogue scale (VAS) by >50% at 6, 12 and/or 24 months after SCS.
Evidence Synthesis: According to the pooled data of double-arm studies, SCS has unanimously proven its superiority over other treatment options at 6 months follow-up; however it fails to prove statistically significant difference in results at longer treatment intervals. Dorsal root ganglion stimulation, a relatively recent technique with the same underlying physiologic mechanisms as SCS, showed far more promising results than SCS. Single-arm studies show around 70% patients experiencing greater than 50% reduction in their VAS scores at 6 and 12 months.
Conclusions: SCS is a viable option for management of chronic neuropathic pain secondary to FBSS and CRPS. However, data available for its long term efficacy remains scarce and show no further statistically significant results.
Evidence Acquisition: We reviewed all the data available on MEDLINE, Embase and Cochrane CENTRAL using a search strategy designed to fit our pre-set inclusion and exclusion criteria. Both single-arm and double-arm studies were included. The primary outcome was defined as decrease of visual analogue scale (VAS) by >50% at 6, 12 and/or 24 months after SCS.
Evidence Synthesis: According to the pooled data of double-arm studies, SCS has unanimously proven its superiority over other treatment options at 6 months follow-up; however it fails to prove statistically significant difference in results at longer treatment intervals. Dorsal root ganglion stimulation, a relatively recent technique with the same underlying physiologic mechanisms as SCS, showed far more promising results than SCS. Single-arm studies show around 70% patients experiencing greater than 50% reduction in their VAS scores at 6 and 12 months.
Conclusions: SCS is a viable option for management of chronic neuropathic pain secondary to FBSS and CRPS. However, data available for its long term efficacy remains scarce and show no further statistically significant results.