Cost-Effectiveness of Spinal Cord Stimulation Therapy in Management of Chronic Pain

Kumar, Krishna; Rizvi, Syed

doi:10.1111/pme.12146

Cited by 149 publications

(137 citation statements)

References 54 publications

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“…6 Studies that have evaluated non-cervicalspecific SCS have also supported its cost-effectiveness in treating pain. 17 Lumbar SCS for chronic pain after failed back surgery syndrome has been associated with improved outcomes 19,27 and decreased complications-without an increase in cost 26 -relative to lumbar reoperation. 20 The extent to which these data apply to cSCS should be explored in future studies.…”

Section: Discussionmentioning

confidence: 99%

Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation

Chan¹,

Winkler²,

Jacques³

2016

SPI

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OBJECTIVE Cervical spinal cord stimulation (cSCS) is used to treat pain of the cervical region and upper extremities. Case reports and small series have shown a relatively low risk of complication after cSCS, with only a single reported case of perioperative spinal cord injury in the literature. Catastrophic cSCS-associated spinal cord injury remains a concern as a result of underreporting. To aid in preoperative counseling, it is necessary to establish a minimum rate of spinal cord injury and surgical complication following cSCS. METHODS The Nationwide Inpatient Sample (NIS) is a stratified sample of 20% of all patient discharges from nonfederal hospitals in the United States. The authors identified discharges with a primary procedure code for spinal cord stimulation (ICD-9 03.93) associated with a primary diagnosis of cervical pathology from 2002 to 2011. They then analyzed short-term safety outcomes including the presence of spinal cord injury and neurological, medical, and general perioperative complications and compared outcomes using univariate analysis. RESULTS Between 2002 and 2011, there were 2053 discharges for cSCS. The spinal cord injury rate was 0.5%. The rates of any neurological, medical, and general perioperative complications were 1.1%, 1.4%, and 11.7%, respectively. There were no deaths. CONCLUSIONS In the largest series of cSCS, the risk of spinal cord injury was higher than previously reported (0.5%). Nonetheless, this procedure remains relatively safe, and physicians may use these data to corroborate the safety of cSCS in an appropriately selected patient population. This may become a key treatment option in an increasingly opioid-dependent, aging population.

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Section: Discussionmentioning

confidence: 99%

Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation

Chan¹,

Winkler²,

Jacques³

2016

SPI

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“…По мнению E.L. Simpson и соавторов [73], статистическая значи-мость свидетельств о клинических преимуществах SCS над консервативной медикаментозной терапией при КИНК недостаточна, вследствие чего расчет эконо-мической эффективности SCS при этой патологии в их обзоре не выполнялся. С другой стороны, K. Kumar и S. Rizvi [74], учитывавшие в анализе различия в качестве жизни пациентов и использовавшие временной гори-зонт до 20 лет, пришли к выводу, что спинальная ней-ростимуляция экономически эффективна при патологи-ях с болевым синдромом не только нейропатического (например, синдром оперированного позвоночника), но и ишемического (КИНК, рефрактерная стенокар-дия) генеза. Вероятность того, что для каждого случая использование SCS будет более эффективно, чем кон-сервативная медикаментозная терапия, с точки зрения соотношения затрат и результата составляет, по их расчетам, не менее 50% при оценке года жизни, нор-мированного по качеству (англ.…”

Section: Reviewsunclassified

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Ashurkov¹,

Levin²,

Murtazin³

et al. 2017

PKiK

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Critical limb ischemia (CLI) is a state of substantial reduction of blood flow in the extremities, mostly due to severe obstruction of the arteries. In lower limbs, it produces severe pain after even a short distance walk (intermittent claudication) and/or skin ulcers or sores. Surgical revascularization is a “golden standard” in CLI therapy, but it is contraindicated or not accessible for a large proportion of patients, while the medical prognosis is poor for conservative therapy. This situation stimulated the development of alternative approaches, including spinal cord stimulation (SCS) and various methods of “indirect” revascularization. In this paper, the authors give a short description of the latest approaches and a detailed review of the SCS method, while paying special attention to the studies that demonstrate not only a palliative effect of SCS (pain reduction), but also clinically significant changes in the indicators of lower limb muscles blood supply. CLI is characterized with a "vicious circle": pain causes reduced mobility and changes in the preferred limb position, which in turn lead to edema triggering an increase of ischemia and further elevation of pain. The clinical effects of SCS in CLI patients are related both with pain relief leading to a break of this vicious circle, and with the direct vasodilatory effects of the stimulation itself. There are several possible biological mechanisms of these actions, but most probably the therapeutic actions of SCS arise from their combination. Examination of different opinions about the appropriateness of spinal cord stimulation in patients with CLI, including those related to the economic efficiency of the method, leads to the conclusion that the evidence on these issues is currently insufficient. The reviewed data demonstrate the need for further development of the CLI treatment methods and high urgency of this problem.Received 6 April 2017. Accepted 23 April 2017.Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest.

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“…Another potential limitation of the routine use of SCS is its cost (20-30 000 Euro per patient). However, recent trial has shown that, in the long-term horizon, spinal cord stimulation is cost effective in refractory angina pain when compared with conventional medical management 60 .…”

Section: Complicationsmentioning

confidence: 99%

Interventional treatment of pain in refractory angina. A review

Dobias¹,

Michálek²,

Neužil³

et al. 2014

BIOMED PAP

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Background. Refractory angina is characterized by repeated attacks of chest pain in patients on maximal anti-anginal pharmacotherapy, with a professional conscensus that further surgical or radiological revascularization would be futile. Refractory angina is a serious but relatively uncommon health problem, with a reported incidence of approximately 30 patients per million people/year. In this condition simply treating the associated pain alone is important as this can improve exercise tolerance and quality of life.Methods. An extensive literature search using five different medical databases was performed and from this, eightythree papers were considered appropriate to include within this review. Results and Conclusion. Available literature highlights several methods of interventional pain treatment, including spinal cord stimulation and video-assisted upper thoracic sympathectomy which can provide good analgesia whilst improving physical activities and quality of life. The positive effect of spinal cord stimulation on the intensity of pain and quality of life has been confirmed in nine randomized controlled trials. Other potential treatment methods include stellate ganglion blocks, insertion of thoracic epidural or spinal catheters and transcutaneous electrical nerve stimulation. These approaches however appear more useful for diagnostic purposes and perhaps as short-term treatment measures.

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Cost-Effectiveness of Spinal Cord Stimulation Therapy in Management of Chronic Pain

Abstract: SCS with CMM is cost-effective compared with CMM alone in the management of FBSS, CRPS, PAD, and RAP.

Cited by 149 publications

References 54 publications

Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation

Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Interventional treatment of pain in refractory angina. A review

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