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Papers of the Week


Papers: 27 Jul 2019 - 2 Aug 2019


2019 Nov


World Neurosurg


131

Waves of Pain Relief: A Systematic Review of Clinical Trials in Spinal Cord Stimulation Waveforms for the Treatment of Chronic Neuropathic Low-Back and Leg Pain.

Authors

Head J, Jacob M, Sabourin V, Turpin J, Hoelscher C, Wu C, Sharan A
World Neurosurg. 2019 Nov; 131:264-274.e3.
PMID: 31369885.

Abstract

In the United States, chronic low-back pain affects up to 37% of adults and is a multi-billion dollar healthcare market. Spinal Cord Simulation (SCS) has been established as an effective treatment alternative for chronic neuropathic low-back and leg pain especially for patients suffering from Failed Back Surgery Syndrome (FBSS) or Chronic Regional Pain Syndrome (CRPS). The field of SCS has rapidly advanced such that analgesia can now be achieved through numerous different waveforms, each claiming to offer improved outcomes. These waveforms include traditional paresthesia-based stimulation (PB-SCS; <100 Hz), paresthesia-free high-frequency stimulation (HF-SCS; 5-10 kHz), burst stimulation, and sub-perception stimulation (SP-SCS; 1-5 kHz). Level 1 evidence critically evaluating the efficacy of these different waveforms is lacking. We conducted a systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines to identify all randomized controlled trials (RCTs) of SCS in the treatment of chronic neuropathic low-back and leg pain, FBSS, or CRPS. A total of 38 eligible studies were reviewed to yield a final 13 RCTs that were included in our systematic review. We review the evidence from RCTs in the field of SCS that have established PB-SCS, HF-SCS, Burst, and SP-SCS as viable treatment options for chronic neuropathic low-back and leg pain. We critically evaluate the evidence that claims to support the use of one waveform over the other and review the literature on patient preference for different waveforms.