Spinal Cord Stimulation 50 Years Later: Clinical Outcomes of Spinal Cord Stimulation Based on Randomized Clinical Trials - A Systematic Review

Nagy Mekhail, Ogi Visnjevac, Gerges Azer, Diana Sue Mehanny, Priya Agrawal, Victor Foorsov

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

To assess the efficacy of spinal cord stimulation (SCS) for each indication, one must critically assess each specific clinical outcome to identify outcomes that benefit from SCS therapy. To date, a comprehensive review of clinically relevant outcome-specific evidence regarding SCS has not been published. We aimed to assess all randomized controlled trials from the world literature for the purpose of evaluating the clinical outcome-specific efficacy of SCS for the following outcomes: perceived pain relief or change pain score, quality of life, functional status, psychological impact, analgesic medication utilization, patient satisfaction, and health care cost and utilization. Interventions were SCS, without limitation to the type of controls or the type of SCS in the active arms. For each study analyzed, a quality assessment was performed using a validated scale that assesses reporting, external validity, bias, confounding, and power. Each outcome was assessed specific to its indication, and the primary measure of each abovementioned outcome was a summary of the level of evidence. Twenty-one randomized controlled trials were analyzed (7 for trunk and limb pain, inclusive of failed back surgery syndrome; 8 for refractory angina pectoris; 1 for cardiac X syndrome; 3 for critical limb ischemia; 2 for complex regional pain syndrome; and 2 for painful diabetic neuropathy). Evidence assessments for each outcome for each indication were depicted in tabular format. Outcome-specific evidence scores were established for each of the abovementioned indications, providing both physicians and patients with a summary of evidence to assist in choosing the optimal evidence-based intervention. The evidence presented herein has broad applicability as it encompasses a breadth of patient populations, variations of SCS therapy, and comparable controls that, together, reflect comprehensive clinical decision making.

Original languageEnglish (US)
Pages (from-to)391-406
Number of pages16
JournalRegional anesthesia and pain medicine
Volume43
Issue number4
DOIs
StatePublished - May 1 2018
Externally publishedYes

Fingerprint

Spinal Cord Stimulation
Randomized Controlled Trials
Pain
Failed Back Surgery Syndrome
Extremities
Microvascular Angina
Patient Acceptance of Health Care
Complex Regional Pain Syndromes
Diabetic Neuropathies
Angina Pectoris
Patient Satisfaction
Health Care Costs
Analgesics
Patient Care
Arm
Ischemia
Quality of Life
Outcome Assessment (Health Care)
Psychology
Physicians

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Spinal Cord Stimulation 50 Years Later : Clinical Outcomes of Spinal Cord Stimulation Based on Randomized Clinical Trials - A Systematic Review. / Mekhail, Nagy; Visnjevac, Ogi; Azer, Gerges; Mehanny, Diana Sue; Agrawal, Priya; Foorsov, Victor.

In: Regional anesthesia and pain medicine, Vol. 43, No. 4, 01.05.2018, p. 391-406.

Research output: Contribution to journalArticle

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