• Pain physician · Sep 2020

    Meta Analysis Comparative Study

    Comparison of Spinal Cord Stimulation Waveforms for Treating Chronic Low Back Pain: Systematic Review and Meta-Analysis.

    • Jay Karri, Vwaire Orhurhu, Sayed Wahezi, Tuan Tang, Timothy Deer, and Alaa Abd-Elsayed.
    • Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX.
    • Pain Physician. 2020 Sep 1; 23 (5): 451-460.

    BackgroundThe treatment of chronic refractory low back pain (LBP) is challenging. Conservative and pharmacologic options have demonstrated limited efficacy. Spinal cord stimulation (SCS) has been shown to be effective in reducing chronic LBP in various contexts. With emerging SCS technologies, the collective evidence of novel waveforms relative to traditional tonic stimulation for treating chronic LBP has yet to be clearly characterized.ObjectivesTo provide evidence for various SCS waveforms-tonic, burst, and high frequency (HF)-relative to each other for treating chronic LBP.Study DesignSystematic review and meta-analysis.MethodsPubMed, Medline, Cochrane Library, prior systematic reviews, and reference lists were screened by 2 separate authors for all randomized trials and prospective cohort studies comparing different SCS waveforms for treatment of chronic LBP.ResultsWe identified 11 studies that included waveform comparisons for treating chronic LBP. Of these, 6 studies compared burst versus tonic, 2 studies compared burst versus HF, and 3 studies compared tonic versus HF. A meta-analysis of 5 studies comparing burst versus tonic was conducted and revealed pooled superiority of burst over tonic in pain reduction. One study comparing burst versus tonic was excluded given technical challenges in data extraction.LimitationsBoth randomized controlled trials and prospective cohort studies were included for meta-analysis. Several studies included a high risk of bias in at least one domain.ConclusionsBurst stimulation is superior to tonic stimulation for treating chronic LBP. However, superiority among other waveforms has yet to be clearly established given some heterogeneity and limitations in evidence. Given the relative novelty of burst and HF SCS waveforms, evidence of longitudinal efficacy is needed.

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