The effect of spinal cord stimulation on pain medication reduction in intractable spine and limb pain: A systematic review of randomized controlled trials and meta-analysis

E. Morgan Pollard, Tim J. Lamer, Susan M. Moeschler, Halena M. Gazelka, W. Michael Hooten, Markus A. Bendel, Nafisseh S. Warner, Mohammad H Murad

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Abstract

Objective: To synthesize the evidence regarding the effect of spinal cord stimulation (SCS) on opioid and pain medication reduction in patients with intractable spine or limb pain. Methods: A comprehensive literature search was conducted to identify RCTs of patients with chronic back and/or limb pain of greater than one year duration. Only comparative studies were included (ie, conventional SCS vs medical therapy, conventional SCS vs highfrequency SCS) and were required to have a minimum follow-up period of 3 months. Random effect meta-an alysis was used to compare the three interventions. Results were expressed as odds ratio (OR) or weighted mean difference (WMD) with 95% confidence intervals (CI). Results: We identified five trials enrolling 489 patients. Three of the trials reported the results as a number of patients who were able to reduce or eliminate opioid consumption in the SCS vs medical therapy group. The odds of reducing opioid consumption were significantly increased in the SCS group compared to medical therapy (OR 8.60, CI {1.93-38.30}). Two of the trials reported the results as mean medication dose reduction as measured by the Medication Quantification Scale (MQS) in the SCS group vs medical therapy group. MQS score significantly decreased in the SCS group and not in the medical group (WMD -1.97, 95% CI {-3.67, -0.27}). One trial reported a number of patients in high-frequency SCS who were able to reduce opioids vs number of patients in conventional SCS group who were able to reduce opioids. Thirty-four percent of the patients in the high-frequency group and 26% of the patients in the conventional SCS group were able to reduce opioid consumption; however, there was not a significant difference between groups (OR 1.43, 95% CI {0.74, 2.78}). This trial also quantified the opioid reduction in morphine equivalent dosage (MED). In the high-frequency SCS group, average MED decreased by 24.8 mg vs average MED decrease of 7.3 mg in the conventional SCS group. Again, the difference between groups did not reach statistical significance (-17.50, CI {-66.27, 31.27}). Conclusions: In patients with intractable spine/limb pain, SCS was associated with increased odds of reducing pain medication consumption. However, results should be treated with caution as available data were limited, and clinical significance of these findings requires further study.

Original languageEnglish (US)
Pages (from-to)1311-1324
Number of pages14
JournalJournal of Pain Research
Volume12
DOIs
StatePublished - Jan 1 2019

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Spinal Cord Stimulation
Meta-Analysis
Spine
Extremities
Randomized Controlled Trials
Pain
Opioid Analgesics
Confidence Intervals
Morphine
Odds Ratio
Group Psychotherapy

Keywords

  • Chronic back pain
  • Chronic limb pain
  • High-frequency spinal stimulations
  • Opioids
  • Pain medications
  • Painful diabetic neuropathy
  • Spinal cord stimulation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

The effect of spinal cord stimulation on pain medication reduction in intractable spine and limb pain : A systematic review of randomized controlled trials and meta-analysis. / Pollard, E. Morgan; Lamer, Tim J.; Moeschler, Susan M.; Gazelka, Halena M.; Hooten, W. Michael; Bendel, Markus A.; Warner, Nafisseh S.; Murad, Mohammad H.

In: Journal of Pain Research, Vol. 12, 01.01.2019, p. 1311-1324.

Research output: Contribution to journalArticle

Pollard, E. Morgan ; Lamer, Tim J. ; Moeschler, Susan M. ; Gazelka, Halena M. ; Hooten, W. Michael ; Bendel, Markus A. ; Warner, Nafisseh S. ; Murad, Mohammad H. / The effect of spinal cord stimulation on pain medication reduction in intractable spine and limb pain : A systematic review of randomized controlled trials and meta-analysis. In: Journal of Pain Research. 2019 ; Vol. 12. pp. 1311-1324.
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abstract = "Objective: To synthesize the evidence regarding the effect of spinal cord stimulation (SCS) on opioid and pain medication reduction in patients with intractable spine or limb pain. Methods: A comprehensive literature search was conducted to identify RCTs of patients with chronic back and/or limb pain of greater than one year duration. Only comparative studies were included (ie, conventional SCS vs medical therapy, conventional SCS vs highfrequency SCS) and were required to have a minimum follow-up period of 3 months. Random effect meta-an alysis was used to compare the three interventions. Results were expressed as odds ratio (OR) or weighted mean difference (WMD) with 95{\%} confidence intervals (CI). Results: We identified five trials enrolling 489 patients. Three of the trials reported the results as a number of patients who were able to reduce or eliminate opioid consumption in the SCS vs medical therapy group. The odds of reducing opioid consumption were significantly increased in the SCS group compared to medical therapy (OR 8.60, CI {1.93-38.30}). Two of the trials reported the results as mean medication dose reduction as measured by the Medication Quantification Scale (MQS) in the SCS group vs medical therapy group. MQS score significantly decreased in the SCS group and not in the medical group (WMD -1.97, 95{\%} CI {-3.67, -0.27}). One trial reported a number of patients in high-frequency SCS who were able to reduce opioids vs number of patients in conventional SCS group who were able to reduce opioids. Thirty-four percent of the patients in the high-frequency group and 26{\%} of the patients in the conventional SCS group were able to reduce opioid consumption; however, there was not a significant difference between groups (OR 1.43, 95{\%} CI {0.74, 2.78}). This trial also quantified the opioid reduction in morphine equivalent dosage (MED). In the high-frequency SCS group, average MED decreased by 24.8 mg vs average MED decrease of 7.3 mg in the conventional SCS group. Again, the difference between groups did not reach statistical significance (-17.50, CI {-66.27, 31.27}). Conclusions: In patients with intractable spine/limb pain, SCS was associated with increased odds of reducing pain medication consumption. However, results should be treated with caution as available data were limited, and clinical significance of these findings requires further study.",
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AU - Lamer, Tim J.

AU - Moeschler, Susan M.

AU - Gazelka, Halena M.

AU - Hooten, W. Michael

AU - Bendel, Markus A.

AU - Warner, Nafisseh S.

AU - Murad, Mohammad H

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N2 - Objective: To synthesize the evidence regarding the effect of spinal cord stimulation (SCS) on opioid and pain medication reduction in patients with intractable spine or limb pain. Methods: A comprehensive literature search was conducted to identify RCTs of patients with chronic back and/or limb pain of greater than one year duration. Only comparative studies were included (ie, conventional SCS vs medical therapy, conventional SCS vs highfrequency SCS) and were required to have a minimum follow-up period of 3 months. Random effect meta-an alysis was used to compare the three interventions. Results were expressed as odds ratio (OR) or weighted mean difference (WMD) with 95% confidence intervals (CI). Results: We identified five trials enrolling 489 patients. Three of the trials reported the results as a number of patients who were able to reduce or eliminate opioid consumption in the SCS vs medical therapy group. The odds of reducing opioid consumption were significantly increased in the SCS group compared to medical therapy (OR 8.60, CI {1.93-38.30}). Two of the trials reported the results as mean medication dose reduction as measured by the Medication Quantification Scale (MQS) in the SCS group vs medical therapy group. MQS score significantly decreased in the SCS group and not in the medical group (WMD -1.97, 95% CI {-3.67, -0.27}). One trial reported a number of patients in high-frequency SCS who were able to reduce opioids vs number of patients in conventional SCS group who were able to reduce opioids. Thirty-four percent of the patients in the high-frequency group and 26% of the patients in the conventional SCS group were able to reduce opioid consumption; however, there was not a significant difference between groups (OR 1.43, 95% CI {0.74, 2.78}). This trial also quantified the opioid reduction in morphine equivalent dosage (MED). In the high-frequency SCS group, average MED decreased by 24.8 mg vs average MED decrease of 7.3 mg in the conventional SCS group. Again, the difference between groups did not reach statistical significance (-17.50, CI {-66.27, 31.27}). Conclusions: In patients with intractable spine/limb pain, SCS was associated with increased odds of reducing pain medication consumption. However, results should be treated with caution as available data were limited, and clinical significance of these findings requires further study.

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KW - Chronic back pain

KW - Chronic limb pain

KW - High-frequency spinal stimulations

KW - Opioids

KW - Pain medications

KW - Painful diabetic neuropathy

KW - Spinal cord stimulation

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