The Cost-Effectiveness of Spinal Cord Stimulation for Complex Regional Pain Syndrome

That a minor injury can trigger a complex regional pain syndrome (CRPS) - multiple system dysfunction, severe and often chronic pain and disability - has fascinated scientists and perplexed clinicians for decades. However, substantial advances across several medical disciplines have recently increased our understanding of CRPS. Compelling evidence implicates biological pathways that underlie aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity in the clinical features of CRPS. Collectively, the evidence points to CRPS being a multifactorial disorder that is associated with an aberrant host response to tissue injury. Varying susceptibility to perturbed regulation of any of the underlying biological pathways probably accounts for the clinical heterogeneity of CRPS.

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“…11,22 CRPS is commonly associated with substantial disability, loss of quality of life and personal and societal economic burden. 26,27 …”

Section: Epidemiologymentioning

confidence: 99%

Clinical features and pathophysiology of complex regional pain syndrome

Marinus

Moseley

Birklein

et al. 2011

The Lancet Neurology

573

461

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“…In addition, it has an advantage over the implanted system for patients requiring higher amplitudes of stimulation. As a result, the rechargeable IPG is gaining popularity due to its small size and ease of maintenance [7,8]. …”

Section: The Technologymentioning

confidence: 99%

Spinal Cord Stimulation in Pain Management: A Review

Jeon

2012

Korean J Pain

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Spinal cord stimulation has become a widely used and efficient alternative for the management of refractory chronic pain that is unresponsive to conservative therapies. Technological improvements have been considerable and the current neuromodulation devices are both extremely sophisticated and reliable in obtaining good results for various clinical situations of chronic pain, such as failed back surgery syndrome, complex regional pain syndrome, ischemic and coronary artery disease. This technique is likely to possess a savings in costs compared with alternative therapy strategies despite its high initial cost. Spinal cord stimulation continues to be a valuable tool in the treatment of chronic disabling pain.

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“…Mancia et al, 14 in a prospective, randomized, controlled, multicenter study, concluded that the patients with combined SCS and medical management were more costly to the healthcare system, but also had significant functional improvement. Kumar et al 15 16 concluded that ''in selected [complex regional pain syndrome] patients, SCS is a cost-effective option as an adjunct to conventional medical management.'' They also concluded that a rechargeable generator is the most cost-effective option, when the predicted generator longevity is >4 years, despite higher initial cost.…”

Section: Permanent Implantationmentioning

confidence: 99%

Managing Chronic Pain With Spinal Cord Stimulation

Epstein

Palmieri

2012

Mount Sinai J Medicine

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Since its introduction as a procedure of last resort in a terminally ill patient with intractable cancer‐related pain, spinal cord stimulation has been used to effectively treat chronic pain of varied origins. Spinal cord stimulation is commonly used for control of pain secondary to failed back surgery syndrome and complex regional pain syndrome, as well as pain from angina pectoris, peripheral vascular disease, and other causes. By stimulating one or more electrodes implanted in the posterior epidural space, the patient feels paresthesias in their areas of pain, which reduces the level of pain. Pain is reduced without the side effects associated with analgesic medications. Patients have improved quality of life and improved function, with many returning to work. Spinal cord stimulation has been shown to be cost effective as compared with conservative management alone. There is strong evidence for efficacy and cost effectiveness of spinal cord stimulation in the treatment of pain associated with intractable angina, failed back surgery syndrome, and complex regional pain syndrome. In this article, we review the history and pathophysiology of spinal cord stimulation, and the evidence (or lack thereof) for efficacy in common clinical practice. Mt Sinai J Med 79:123–132, 2012. © 2012 Mount Sinai School of Medicine

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The Cost-Effectiveness of Spinal Cord Stimulation for Complex Regional Pain Syndrome

Cited by 72 publications

References 21 publications

Clinical features and pathophysiology of complex regional pain syndrome

Clinical features and pathophysiology of complex regional pain syndrome

Spinal Cord Stimulation in Pain Management: A Review

Managing Chronic Pain With Spinal Cord Stimulation

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