Spinal Cord Stimulation Reduces Pain From Failed Back Surgery

For over 30 years now, doctors have used spinal cord stimulation (SCS), also called neurostimulation, to help relieve chronic pain. A stimulator is implanted into the patient's body, which then sends out impulses to interrupt the pain signals and prevent them from reaching the brain. It's important to understand that the treatment doesn't eliminate pain, but it prevents the person from feeling it as much, thus masking it. SCS is generally only used if nothing else seems to be working and must be done on a trial basis first before the stimulator is permanently implanted. Patients also must have a psychological assessment to be sure that they are ready for this type of treatment.

Some doctors working with patients who have failed back surgery syndrome have tried using SCS to treat the pain experienced by their patients, however there aren't many studies that have looked into this use and if it is a cost efficient treatment. The authors of this article reviewed studies that looked at the pain reduction and cost effectiveness of SCS in this patient group. To do this, researchers searched the medical literature to find randomized controlled trials that included patients with failed back surgery syndrome. Some studies that were observational were included if there was a control group.

Patients in the studies had chronic pain lasting more than six months, due to failed back surgery syndrome. The study follow ups lasted anywhere from six to months to eight years. Cases had at least 50 patients who had received stimulators and were followed for at least one year. In order to assess patients' pain and level of functioning, the researchers depended on scales and questionnaires, such as the McGill Pain Questionnaire (MPQ) and the VIsual Analog Scale (VAS). The researchers also looked at the economic impact of the pain and the treatment.

After reviewing the appropriate studies and cases, the researchers found that the studies and cases consistently found that it was cost effective to use SCS in treating failed back surgery syndrome, although several studies did report complications. The complications included mostly technical problems with the hardware.

The studies included a low-quality study that found no differences in the number of patients who were given the stimulators and the control group (those who didn't receive a stimulator) returning to work after six months of treatment and another low-quality study that found that patients with stimulators woke less often at night than controls after one year of treatment. Another seven low-quality studies found that there were improvement in activities of daily living in patients with stimulators after one year of treatment, but only one had improvement in sleep findings. Another study concluded that their patients who were depressed saw an improvement in the depression after being treated. Several studies measured drug use for pain relief before and after treatment. They all found that there was no significant changes in the use of medications, except for one that did find treated patients used fewer medications.

In terms of satisfaction with treatment, those who received treatments were much more satisfied than the control groups in two moderate-quality studies and three low-quality studies reported 60 percent of the treated patients or more were satisfied after three years of treatment.

When the researchers examined the economic aspect of SCS, one study found that the mean cost for the treatment, over five years, was higher in the initial treatment phase because of the cost of obtaining and implanting the stimulator. However, once the initial expenses were taken care of, the cost of treatment leveled off.

The authors wrote that the studies they reviewed did show that there was a significant benefit to SCS in terms of reducing pain and improving quality of life in patients with chronic pain from failed back surgery syndrome. There was also indication that, despite the high initial cost of the treatment, SCS over the long-term was more cost effective than other treatments.

Malgorzata M. Bala, MD, PhD, et al. Systemic Review of the (Cost)-effectiveness of Spinal Cord Stimulation for People With Failed Back Surgery Syndrome. In Clinical Journal of Pain. November/December 2008. Vol. 24. No. 9. pp. 741-755.

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