Predictors of pain relief following spinal cord stimulation in chronic back and leg pain and failed back surgery syndrome: a systematic review and meta-regression analysis

Taylor, R. S. , Desai, M. J., Rigoard, P. and Taylor, R. J. (2014) Predictors of pain relief following spinal cord stimulation in chronic back and leg pain and failed back surgery syndrome: a systematic review and meta-regression analysis. Pain Practice, 14(6), pp. 489-505. (doi: 10.1111/papr.12095) (PMID:23834386) (PMCID:PMC4238825)

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Abstract

We sought to assess the extent to which pain relief in chronic back and leg pain (CBLP) following spinal cord stimulation (SCS) is influenced by patient‐related factors, including pain location, and technology factors. A number of electronic databases were searched with citation searching of included papers and recent systematic reviews. All study designs were included. The primary outcome was pain relief following SCS, we also sought pain score (pre‐ and post‐SCS). Multiple predictive factors were examined: location of pain, history of back surgery, initial level of pain, litigation/worker's compensation, age, gender, duration of pain, duration of follow‐up, publication year, continent of data collection, study design, quality score, method of SCS lead implant, and type of SCS lead. Between‐study association in predictive factors and pain relief were assessed by meta‐regression. Seventy‐four studies (N = 3,025 patients with CBLP) met the inclusion criteria; 63 reported data to allow inclusion in a quantitative analysis. Evidence of substantial statistical heterogeneity (P < 0.0001) in level of pain relief following SCS was noted. The mean level of pain relief across studies was 58% (95% CI: 53% to 64%, random effects) at an average follow‐up of 24 months. Multivariable meta‐regression analysis showed no predictive patient or technology factors. SCS was effective in reducing pain irrespective of the location of CBLP. This review supports SCS as an effective pain relieving treatment for CBLP with predominant leg pain with or without a prior history of back surgery. Randomized controlled trials need to confirm the effectiveness and cost‐effectiveness of SCS in the CLBP population with predominant low back pain.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Taylor, Professor Rod
Authors: Taylor, R. S., Desai, M. J., Rigoard, P., and Taylor, R. J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:Pain Practice
Publisher:Wiley
ISSN:1530-7085
ISSN (Online):1533-2500
Published Online:08 July 2013
Copyright Holders:Copyright © 2013 The Authors
First Published:First published in Pain Practice 14(6):489-505
Publisher Policy:Reproduced under a Creative Commons license

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