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
ReviewSpinal cord stimulation for the management of refractory angina pectoris.
Despite sophisticated medical and surgical procedures, including percutaneous endovascular methods, a large number of patients suffer from chronic refractory angina pectoris. Improvement of pain relief in this category of patients requires the use of adjuvant therapies, of which spinal cord stimulation (SCS) seems to be the most promising. ⋯ This technique is still met with reluctance by the medical community. Reasons for this disinclination may be related to incomplete understanding of the mechanism of action of SCS and the fact that SCS refers to the modulation of neuroendocrine parameters rather than to revascularization, which is currently the dominant treatment paradigm in coronary artery disease.
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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.
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J Pain Symptom Manage · Apr 2006
ReviewComplex regional pain syndrome: manifestations and the role of neurostimulation in its management.
The hallmark of complex regional pain syndrome (CRPS) is excruciating pain (aching, burning, pricking, or shooting). Diagnosis should be established as soon as possible, as response to treatment is adversely affected by any delay. Treatment of CRPS is aimed at improving function, using an interdisciplinary, time-dependent, patient-dependent approach that encompasses rehabilitation, psychological therapy, and pain management. ⋯ SCS has been shown to be highly effective in the treatment of CRPS type I, resulting in a significant, long-term reduction in pain and improvement in quality of life. SCS is particularly effective at helping to restore function in affected extremities, especially if applied early in the course of the disease. SCS is also cost effective and improves health-related quality of life.
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J Pain Symptom Manage · Apr 2006
ReviewNeurostimulation for chronic neuropathic back pain in failed back surgery syndrome.
Failed back surgery syndrome (FBSS) is defined as persistent or recurrent pain, mainly in the lower back and/or legs, even after previous anatomically successful spinal surgery. Treatment of such patients is difficult, with conservative therapy and repeated back surgery often proving unsuccessful at providing adequate pain relief. Spinal cord stimulation (SCS) is a minimally invasive procedure that allows physicians and patients to inexpensively evaluate the response to therapy before permanent implantation. ⋯ Patients express great satisfaction with SCS and minimal side effects are observed. Moreover, SCS has been shown to be a cost-effective alternative to conventional therapies. Thus, SCS is the treatment of choice in medically refractory FBSS patients where recurrent neuropathic pain persists after surgery and analgesics are no longer effective or accompanied by intolerable side effects.