Waves of Pain Relief: A Systematic Review of Clinical Trials in Spinal Cord Stimulation Waveforms for the Treatment of Chronic Neuropathic Low Back and Leg Pain.
Publication/Presentation Date
11-1-2019
Abstract
In the United States, chronic low back pain affects up to 37% of adults and is a multibillion dollar health care expenditure. Spinal cord simulation (SCS) has been established as an effective treatment alternative for chronic neuropathic low back and leg pain, especially for patients with failed back surgery syndrome or chronic regional pain syndrome. The field of SCS has rapidly advanced such that analgesia can now be achieved through numerous different waveforms, each claiming to offer improved outcomes. These waveforms include traditional paresthesia-based SCS (Hz), paresthesia-free high-frequency SCS (5-10 kHz), burst SCS, and subperception SCS (1-5 kHz). Level 1 evidence critically evaluating the efficacy of these different waveforms is lacking. We conducted a systematic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify all randomized controlled trials of SCS in the treatment of chronic neuropathic low back and leg pain, failed back surgery syndrome, or chronic regional pain syndrome. Of 38 eligible studies reviewed, 13 randomized controlled trials were finally included in our systematic review. We reviewed evidence from randomized controlled trials in the field of SCS that have established paresthesia-based SCS, paresthesia-free high-frequency SCS, burst SCS, and subperception SCS as viable treatment options for chronic neuropathic low back and leg pain. We critically evaluated evidence that claims to support the use of one waveform over another and reviewed the literature on patient preference for different waveforms.
Volume
131
First Page
264
Last Page
274
ISSN
1878-8769
Published In/Presented At
Head, J., Mazza, J., Sabourin, V., Turpin, J., Hoelscher, C., Wu, C., & Sharan, A. (2019). Waves of Pain Relief: A Systematic Review of Clinical Trials in Spinal Cord Stimulation Waveforms for the Treatment of Chronic Neuropathic Low Back and Leg Pain. World neurosurgery, 131, 264–274.e3. https://doi.org/10.1016/j.wneu.2019.07.167
Disciplines
Medicine and Health Sciences
PubMedID
31369885
Department(s)
Department of Surgery
Document Type
Article