Studies cast doubt on benefit of spinal cord stumlation treatment

Date: 02nd November 2022 | By: Dr Lourdes Gaspar

spinal cord stimulation

Two recent studies cast doubt on the benefit of Spinal Cord Stimulation therapy in chronic pain

Spinal cord stimulation works by sending small electrical impulses to your spinal cord. An electrode is placed over the spinal cord and is powered by a battery which is implanted in the buttock or abdomen. Stimulation helps to block the pain signals travelling to the brain. It may feel like a tingling sensation which may help reduce your pain. You may not feel any tingling sensation. The amount your pain may be reduced varies from person to person.

There are many different forms of stimulation which have evolved using different modes of stimulation. The main differences in stimulation. They fall into the following categories.

  1. Conventional or low frequency stimulation – approximately 40-60HZ
  2. Hight frequency stimulation- 10 KHZ or greater
  • Dorsal root ganglion stimulation – targeting individual nerve roots
  1. Burst stimulation – intermittent or closely spaced stimulation

The effectiveness and long- term outcomes of spinal cord stimulation (SCS) are not fully established

Two recent studies one from Israel and on from Norway have both questioned the effectiveness of these treatments.

The study from Israel looked at conventional spinal cord stimulation in patient with chronic pain from peripheral neuropathic pain (63 out of the 176 patients, 35.8%), failed back surgery syndrome (64, 36.4%), lower back pain (24, 13.6%), complex regional pain syndrome (18, 10.2%) and headaches or other types of pain (7, 4%).

They concluded “that in summary, after controlling for natural variations over time in the outcome measures, the results suggest that although SCS offers a short-term pain relief to the majority of chronic pain patients, only about 40% of them experience adequate pain relief in the long run (7-month post-implantation).

The study form Norway looked at chronic pain after lumbar spine surgery using burst stimulation.

They concluded “Among patients with chronic radicular pain after lumbar spine surgery, spinal cord burst stimulation, compared with placebo stimulation, after placement of a spinal cord stimulator resulted in no significant difference in the change from baseline in self-reported back pain–related disability.”

 

Both studies have come in for criticism from various quarters especially those who would be considered SCS implanters or enthusiast.

Many of the studies which show benefit from SCS treatment have been criticised for

  1. Relatively small samples (median of 38 participants)
  2. Relatively short follow-up (median of 12weeks, although it ranged between 0 and 208weeks)
  • The majority of the studies were sponsored by the devices’ manufacturers, a potential bias towards higher likelihood of positive outcome

At ACT for PAIN, we believe is a treatment which can be applied to a tiny proportion of chronic pain problems. At best it provides partial pain relief (average about 50% reduction) for about 2 years.

There is no published data about its effectiveness after 2 years. In our experience many patients say it stops working with time.

We believe even for successfully implanted patients with SCS, chronic pain has ongoing intrusive impact on their lives and remains important to develop psychological coping strategies to help them in their daily struggles with chronic pain.

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