Prevalence of smoking in adults with spinal cord stimulators: a systematic review and meta-analysis

Hooten, W. Michael; Moman, Rajat N.; Dvorkin, Jodie; Pollard, Emily M.; Wonderman, Robalee; Murad, M. Hassan

doi:10.1136/rapm-2019-100996

Cited by 5 publications

(4 citation statements)

References 46 publications

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“…Most reviews focused on SCS therapy success and utility, and seven evaluated the predictors of SCS success 17 31 51 55 57 58 62. No reviews investigated the merits or disadvantages of trial screening.…”

Section: Resultsmentioning

confidence: 99%

“…Sparkes et al observed mania and hysteria to be associated with improved pain relief, while depression to be associated with poorer outcomes 51. Hooten et al observed that the prevalence of smoking in the SCS population overall was higher than in the general population 31. Overall, most reviews concluded that SCS therapy was better than CMM for chronic pain related to axial pain in the non-operated back, PSPS, PVD, DN, and chronic angina pectoris.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

Shanthanna

Eldabe

Provenzano³

et al. 2023

Reg Anesth Pain Med

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Background/importancePatient selection for spinal cord stimulation (SCS) therapy is crucial and is traditionally performed with clinical selection followed by a screening trial. The factors influencing patient selection and the importance of trialing have not been systematically evaluated.ObjectiveWe report a narrative review conducted to synthesize evidence regarding patient selection and the role of SCS trials.Evidence reviewMedline, EMBASE and Cochrane databases were searched for reports (any design) of SCS in adult patients, from their inception until March 30, 2022. Study selection and data extraction were carried out using DistillerSR. Data were organized into tables and narrative summaries, categorized by study design. Importance of patient variables and trialing was considered by looking at their influence on the long-term therapy success.FindingsAmong 7321 citations, 201 reports consisting of 60 systematic reviews, 36 randomized controlled trials (RCTs), 41 observational studies (OSs), 51 registry-based reports, and 13 case reports on complications during trialing were included. Based on RCTs and OSs, the median trial success rate was 72% and 82%, and therapy success was 65% and 61% at 12 months, respectively. Although several psychological and non-psychological determinants have been investigated, studies do not report a consistent approach to patient selection. Among psychological factors, untreated depression was associated with poor long-term outcomes, but the effect of others was inconsistent. Most RCTs except for chronic angina involved trialing and only one RCT compared patient selection with or without trial. The median (range) trial duration was 10 (0–30) and 7 (0–56) days among RCTs and OSs, respectively.ConclusionsDue to lack of a consistent approach to identify responders for SCS therapy, trialing complements patient selection to exclude patients who do not find the therapy helpful and/or intolerant of the SCS system. However, more rigorous and large studies are necessary to better evaluate its role.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

Shanthanna

Eldabe

Provenzano³

et al. 2023

Reg Anesth Pain Med

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“…However, smoking is associated with accelerated spine degeneration, impaired surgical wound healing, and increased risk of infection in patients having spine surgery 74 75. A systematic review observed an overall smoking prevalence of 38% in patients with SCS,76 with differing rates among subgroups (56% when considered only for patients with PVD; and 28% in patients with lumbar spine diagnosis). Mekhail et al demonstrated that current smokers report significantly higher pain scores and opioid use (2.4 times) compared with non-smokers or former smokers 30 77.…”

Section: Committee Statements and Recommendationsmentioning

confidence: 99%

Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain

Shanthanna

Eldabe

Provenzano³

et al. 2023

Reg Anesth Pain Med

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Spinal cord stimulation (SCS) has demonstrated effectiveness for neuropathic pain. Unfortunately, some patients report inadequate long-term pain relief. Patient selection is emphasized for this therapy; however, the prognostic capabilities and deployment strategies of existing selection techniques, including an SCS trial, have been questioned. After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, a steering committee was formed to develop evidence-based guidelines for patient selection and the role of an SCS trial. Representatives of professional organizations with clinical expertize were invited to participate as committee members. A comprehensive literature review was carried out by the steering committee, and the results organized into narrative reports, which were circulated to all the committee members. Individual statements and recommendations within each of seven sections were formulated by the steering committee and circulated to members for voting. We used a modified Delphi method wherein drafts were circulated to each member in a blinded fashion for voting. Comments were incorporated in the subsequent revisions, which were recirculated for voting to achieve consensus. Seven sections with a total of 39 recommendations were approved with 100% consensus from all the members. Sections included definitions and terminology of SCS trial; benefits of SCS trial; screening for psychosocial characteristics; patient perceptions on SCS therapy and the use of trial; other patient predictors of SCS therapy; conduct of SCS trials; and evaluation of SCS trials including minimum criteria for success. Recommendations included that SCS trial should be performed before a definitive SCS implant except in anginal pain (grade B). All patients must be screened with an objective validated instrument for psychosocial factors, and this must include depression (grade B). Despite some limitations, a trial helps patient selection and provides patients with an opportunity to experience the therapy. These recommendations are expected to guide practicing physicians and other stakeholders and should not be mistaken as practice standards. Physicians should continue to make their best judgment based on individual patient considerations and preferences.

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“…Comorbid psychiatric conditions such as major depressive disorder and anxiety disorders, which are particularly common within the chronic pain population, should be similarly optimized prior to surgery to maximize pain relief (37)(38)(39). Finally, tobacco use diminishes the responder rates of SCS, and providers should consider discussing smoking cessation with patients prior to impantation (40).…”

Section: Patient Selectionmentioning

confidence: 99%

Spinal Cord Stimulation as Treatment for Cancer and Chemotherapy-Induced Pain

et al. 2021

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Neuropathic pain is a rampant disease exacting a significant toll on patients, providers, and health care systems around the globe. Neuromodulation has been successfully employed to treat many indications including failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), phantom limb pain (PLP), radiculopathies, and intractable pelvic pain, among many others. Recent studies have also demonstrated efficacy for cancer-related pain and chemotherapy induced neuropathy with these techniques. Spinal cord stimulation (SCS) is the most commonly employed technique and involves implantation of percutaneous or paddle leads targeting the dorsal columns of the spinal cord with the goal of disrupting the pain signals traveling to the brain. Tonic, high frequency, and burst waveforms have all been shown to reduce pain and disability in chronic pain patients. Closed-loop SCS systems that automatically adjust stimulation parameters based on feedback (such as evoked compound action potentials) are becoming increasingly used to help ease the burden placed on patients to adjust their programming to their pain and position. Additionally, dorsal root ganglion stimulation (DRGS) is a newer technique that allows for dermatomal coverage especially in patients with pain in up to two dermatomes. Regardless of the technique chosen, neuromodulation has been shown to be cost-effective and efficacious and should be given full consideration in patients with chronic pain conditions.

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Prevalence of smoking in adults with spinal cord stimulators: a systematic review and meta-analysis

Cited by 5 publications

References 46 publications

Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain

Spinal Cord Stimulation as Treatment for Cancer and Chemotherapy-Induced Pain

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