Physical functioning following spinal cord stimulation: a systematic review and meta-analysis

Abstract

BackgroundSpinal cord stimulation (SCS) has emerged as an important treatment for chronic pain disorders. While there is evidence supporting improvement in pain intensity with SCS therapy, efforts to synthesize the evidence on physical functioning are lacking.ObjectiveThe primary objective of this meta-analysis was to assess long-term physical function following 12 months of SCS for chronic back pain.Evidence reviewPubMed, EMBASE, Scopus, and CENTRAL databases were searched for original peer-reviewed publications investigating physical function following SCS. The primary outcome was physical function at 12 months following SCS therapy for chronic back pain compared with baseline. A random effects model with an inverse variable method was used. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to determine the certainty of evidence.FindingsA total of 518 studies were screened, of which 36 were included. Twenty-two studies were pooled in the meta-analysis. There was a significant reduction in Oswestry Disability Index (ODI) scores at all time frames up to 24 months following implantation. Pooled results revealed significant improvement in ODI scores at 12 months with a mean difference of −17.00% (95% CI −23.07 to −10.94, p<0.001). There was a very low certainty of evidence in this finding as per the GRADE framework. There was no significant difference in subgroup analyses based on study design (randomised controlled trials (RCTs) vs non-RCTs), study funding, or stimulation type.ConclusionThis meta-analysis highlights significant improvements in physical function after SCS therapy. However, this finding was limited by a very low GRADE certainty of evidence and high heterogeneity.

Narrative reviews in anesthesia and pain medicine: guidelines for producers, reviewers and consumers

“…As an example specific to pain medicine and which adhered to the PRISMA reporting guidelines, a systematic review with meta-analysis executed an a priori registered protocol to investigate whether patients with chronic pain disorders treated with spinal cord stimulation led to improvements in physical function from baseline compared with 12-month follow-up. 36 This meta-analysis identified a statistically significant improvement in Oswestry Disability Index scores after 12 months of spinal cord stimulation (mean difference −17.00%, 95% CI −23.07 to −10.94, p<0.001) which also met the threshold for the minimal clinically important difference (MCID), although there was very low certainty evidence in this finding per the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) framework due to high risk of bias, presence of clinical, methodological, and statistical heterogeneity, and possibility for small study effects. 36 Similarly, a systematic review without meta-analysis should adhere to PRISMA guidelines, as highlighted in a systematic review that assessed the impact of the COVID-19 pandemic versus historical controls predating the pandemic on opioidrelated outcomes in participants with or at risk of opioid use, misuse, or opioid use disorder.…”

“…36 This meta-analysis identified a statistically significant improvement in Oswestry Disability Index scores after 12 months of spinal cord stimulation (mean difference −17.00%, 95% CI −23.07 to −10.94, p<0.001) which also met the threshold for the minimal clinically important difference (MCID), although there was very low certainty evidence in this finding per the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) framework due to high risk of bias, presence of clinical, methodological, and statistical heterogeneity, and possibility for small study effects. 36 Similarly, a systematic review without meta-analysis should adhere to PRISMA guidelines, as highlighted in a systematic review that assessed the impact of the COVID-19 pandemic versus historical controls predating the pandemic on opioidrelated outcomes in participants with or at risk of opioid use, misuse, or opioid use disorder. 37 The authors concluded that surrogate measures of the opioid crisis, such as emergency department visits for opioid use disorder and urine drug testing positivity for illicit substances, increased and coincided with the onset of the COVID-19 pandemic, although GRADE certainty of evidence ranged from low to very low.…”

Misinformation Persists in Complementary Health: Evaluating the Reliability and Quality of YouTube-Based Information on the Use of Acupuncture for Chronic Pain

“…2 Current treatment options for chronic pain include instituting a multimodal treatment plan consisting of conservative therapy (physical therapy, cognitive-behavioral therapy, and complementary and alternative medicine therapies), analgesics such as opioids, non-steroidal anti-inflammatory drugs, and neuropathic agents, as well as interventional treatment such as injections and neuromodulation. [3][4][5] Acupuncture is a technique based on traditional Chinese medicine that is commonly used to manage chronic pain syndromes. The exact mechanism of analgesia from acupuncture is still unclear; however, it is believed to be due to release of anti-inflammatory and inhibitory neurotransmitters following the stimulation of acupoints.…”