Spinal cord stimulation for complex regional pain syndrome: a systematic review of the clinical and cost-effectiveness literature and assessment of prognostic factors.

Abstract

OBJECTIVE:

To review the clinical and cost-effectiveness of spinal cord stimulation (SCS) in the management of patients with complex regional pain syndrome (CRPS) and identify the potential predictors of SCS outcome.

DESIGN:

Systematic review of the literature and meta-regression.

METHODS:

Electronic databases were searched for controlled and uncontrolled studies and economic evaluations relating to the use of SCS in patients with either CRPS type I or II.

RESULTS:

One randomised controlled trial, 25 case series and one cost-effectiveness study were included. In the randomised controlled trial in type I CRPS patients, SCS therapy lead to a reduction in pain intensity at 24 months of follow-up (mean change in VAS score -2.0), whereas pain was unchanged in the control group (mean change in VAS score 0.0) (p<0.001). In the case series studies, 67% (95% CI 51%, 84%) of type I and type II CRPS patients implanted with SCS reported pain relief of at least 50% over a median follow-up period of 33 months. No statistically significant predictors of pain relief with SCS were observed in multivariate meta-regression analysis across studies. An economic analysis based on the randomised controlled trial showed a lifetime cost saving of approximately 58,470 (60,800 US dollars) with SCS plus physical therapy compared with physical therapy alone. The mean cost per quality-adjusted life-year at 12-month follow-up was 22,580 (23,480 US dollars).

CONCLUSIONS:

SCS appears to be an effective therapy in the management of patients with CRPS type I (Level A evidence) and type II (Level D evidence). Moreover, there is evidence to demonstrate that SCS is a cost-effective treatment for CRPS type I.

• Authors: Rod S Taylor, Jean-Pierre Van Buyten, Eric Buchser
• Journal: European journal of pain (London, England) (Eur J Pain) Vol. 10 Issue 2 Pg. 91-101 (Feb 2006) ISSN: 1090-3801 [Print] England
• PMID: 16310712 (Publication Type: Journal Article, Review, Systematic Review)

Topics

• Complex Regional Pain Syndromes (economics, therapy)
• Cost-Benefit Analysis
• Electric Stimulation Therapy (economics)
• Humans
• Prognosis
• Spinal Cord