Journal of pain and symptom management
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J Pain Symptom Manage · Apr 2006
Review Meta AnalysisSpinal cord stimulation in complex regional pain syndrome and refractory neuropathic back and leg pain/failed back surgery syndrome: results of a systematic review and meta-analysis.
The drive for good quality evidence has highlighted the importance of well-conducted systematic reviews and meta-analyses that critically evaluate and grade studies for new or existing therapies. A systematic review and meta-analysis was performed to review the efficacy, safety, and cost effectiveness of spinal cord stimulation (SCS) in complex regional pain syndrome (CRPS) and refractory neuropathic back and leg pain/failed back surgery syndrome (FBSS). The results support the use of SCS in patients with refractory neuropathic back and leg pain/FBSS (Grade B evidence) and CRPS type I (Grade A evidence)/type II (Grade D evidence). SCS not only reduces pain, improves quality of life, reduces analgesic consumption, and allows some patients to return to work, with minimal significant adverse events, but may also result in significant cost savings over time.
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J Pain Symptom Manage · Apr 2006
Review Meta AnalysisSpinal cord stimulation for critical leg ischemia: a review of effectiveness and optimal patient selection.
Patients suffering from inoperable critical leg ischemia (CLI) ultimately face a major amputation. Spinal cord stimulation (SCS) has been introduced as a possible treatment option. This paper presents the best available evidence from a systematic review on the effectiveness of SCS in these patients and discusses the indications for SCS therapy. ⋯ These positive effects have to be weighed against the higher costs and (generally minor) complications of SCS. TcpO(2) measurements were found to be useful in selecting the most respondent patients, yielding a 12-month limb salvage up to 83%. Hence, SCS should be considered as a possible treatment option in patients with CLI, particularly if their foot TcpO(2) is between 10 and 30 mmHg.