Spinal Cord Stimulation Versus Conventional Medical Management of Neuropathic Pain: A Multicentre Randomised Controlled Trial In Patients with Failed Back Surgery Syndrome.

Kumar K,Taylor R, Jacques L, Eldabe S, Megilo M, Molet J, Thomson S, O'Callaghan J, Eisenburg E,Milbouw, Buchser E, Fortini G, Richardson J, North R.

In this study 100 patients suffering from neuropathic pain secondary to failed back surgery syndrome (defined as patients who had undergone surgery to correct a herniated disc at least once which had little to no effect on the pain experienced). These patients were randomised into either a spinal cord stimulation (SCS) or conventional medical management group. Both groups were treated with a non-scs component which was decided at the discretion of the investigator which was shaped by local practice. This included but was not limited to opoids, NSAIDs, nerve blocks and rehabilitative therapy. Those randomised into the SCS group were further assessed and those that experienced "at least 80% overlap of their pain with stimulation induced paresthesia and at least 50% leg pain relief received an implantable neurostimulation system"

Outcome measures used were the V.A.S. to measure pain, the Short Form 36 questionnaire (a measure of quality of life) as well as the Oswestry Disability index (a measure of functional capacity). At the 6 month follow up 48% of the SCS group and 9% of the CMM group reported a 50% decrease in pain. The SCS group also had higher scores on functional, quality of life and satisfaction of treatment measures. However there was no difference in return to work. At the 12 month follow up these statistics had decreased 34% (SCS group) and 7% (CMM group) of the of the original randomised patients reported 50% reduction on original pain scores.

Despite this apparent reduction in effectiveness the authors concluded that SCS is more effective then conventional medical management in patients with neuropathic pain.

Pain, 2007, 132, 179-188

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