A Comprehensive Outcome-Specific Review of the Use of Spinal Cord Stimulation for Complex Regional Pain Syndrome.
Background Complex regional pain syndrome ( CRPS) is a painful, debilitating affliction that is often difficult to treat. It has become common international practice to use spinal cord stimulation ( SCS) for the treatment of CRPS as other therapies fail to provide adequate relief, quality of life, o...
| Published in: | Pain Practice Vol. 17; no. 4; pp. 533 - 546 |
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| Main Authors: | , , , , , , |
| Format: | research systematic review tables/charts Journal Article |
| Published: |
Wiley-Blackwell
Apr2017
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=122381295&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 122381295 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15307085 HYN jtl: Pain Practice issn: 15307085 maglogo: Y pubinfo: dt: Apr2017 vid: 17 iid: 4 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 122381295 122381295 122381295 10.1111/papr.12513 122381295 ppf: 533 ppct: 13 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: A Comprehensive Outcome-Specific Review of the Use of Spinal Cord Stimulation for Complex Regional Pain Syndrome. aug: au: Visnjevac, Ognjen Costandi, Shrif Patel, Bimal A. Azer, Girgis Agarwal, Priya Bolash, Robert Mekhail, Nagy A. affil: Pain Management Department, Cleveland Clinic, Cleveland Ohio, U.S.A sug: subj: Spinal Cord Stimulation Causalgia Reflex Sympathetic Dystrophy Human Systematic Review Pain Management Sleep Hygiene Quality of Life Patient Satisfaction ab: Background Complex regional pain syndrome ( CRPS) is a painful, debilitating affliction that is often difficult to treat. It has become common international practice to use spinal cord stimulation ( SCS) for the treatment of CRPS as other therapies fail to provide adequate relief, quality of life, or improvement in function. This comprehensive outcome-specific systematic review of the use of SCS for CRPS was performed to elucidate the available evidence with focus on clinically relevant patient-specific outcomes. Methods A systematic review of the literature was conducted to evaluate the effects of SCS on patients with CRPS for the following outcomes and provide summary levels of evidence in regard to each outcome: perceived pain relief, pain score, resolution of CRPS signs, functional status, quality of life, psychological impact, sleep hygiene, analgesic medication utilization, and patient satisfaction with SCS therapy. Search terms included 'complex regional pain syndrome,' 'spinal cord stimulation,' and 'reflex sympathetic dystrophy,' without restriction of language, date, or type of publication, albeit only original data were included in analyses. Of 30 studies selected, seven systematic reviews were excluded, as were four studies reporting combination therapy that included SCS and other therapies (ie, concurrent peripheral nerve stimulation, intrathecal therapy) without clear delineation to the effect of SCS alone on outcomes. A total of 19 manuscripts were evaluated. Results Perceived pain relief, pain score improvement, quality of life, and satisfaction with SCS were all rated 1B+, reflecting positive high-level (randomized controlled trial) evidence favoring SCS use for the treatment of CRPS. Evidence for functional status improvements and psychological effects of SCS was inconclusive, albeit emanating from a randomized controlled trial (evidence level 2B±), and outcomes evidence for both sleep hygiene and resolution of CRPS signs was either nonexistent or of too low quality from which to draw conclusions (evidence level 0). An analgesic sparing effect was observed in nonrandomized reports, reflecting an evidence level of 2C+. Conclusions Spinal cord stimulation remains a favorable and effective modality for treating CRPS with high-level evidence (1B+) supporting its role in improving CRPS patients' perceived pain relief, pain score, and quality of life. A paucity of evidence for functional improvements, resolution of CRPS signs, sleep hygiene, psychological impact, and analgesic sparing effects mandate further investigation before conclusions can be drawn for these specific outcomes. pubtype: Academic Journal doctype: research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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