Spinal Cord Stimulation

Spinal Cord Stimulation

PEP Topic 
Chronic Pain
Description 

Spinal cord stimulation involves placement of electrodes in the epidural space by either an open surgical procedure or via epidural needles. The electrodes are connected to an impulse generator that is programmed to deliver impulses in either preset patterns or continuously in order to relieve pain. The mechanism of potential action is based on the gate control theory of pain perception. Spinal cord stimulation has been evaluated in patients with cancer for pain management.

Effectiveness Not Established

Systematic Review/Meta-Analysis

Lihua, P., Su, M., Zejun, Z., Ke, W., & Bennett, M.I. (2013). Spinal cord stimulation for cancer-related pain in adults. Cochrane Database of Systematic Reviews, 2, CD009389.

doi: 10.1002/14651858.CD009389.pub2
Print

Purpose:

To review the evidence regarding spinal cord stimulation for pain management in cancer

This study is a systematic review.

Search Strategy:

Databases searched were the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Chinese Biomedical Database (up to July 2012), National Cancer Institute trial registry, World Health Organization International Clinical Trials Registry Platform, and clinicaltrials.gov, supported by the National Institutes of Health. The authors also hand-searched relevant articles.

Search terms were text words combined with medical subject headings (MeSH) terms for electrostimulation and cancer.

Studies were included in the review if they were randomized controlled trials (RCTs) or nonrandomized trials comparing spinal cord stimulation with another intervention for cancer pain.

All studies had to report on adult patients.

Literature Evaluated:

A total of 430 references were retrieved.

The authors assessed risk of bias from sequence assignment and allocation concealment. No specific rating scale is mentioned. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist was used for observational studies, as no RCTs were found.

Sample Characteristics:

  • A final number of four pre-post case reviews were included.
  • The sample range across studies was 11–454 patients. The large study was a retrospective review.
  • Key sample characteristics were not specified.

Phase of Care and Clinical Applications:

The study has clinical applicability for palliative care.

Results:

There were very few studies, and prospective studies were pre-post case series reports. More than 80% of patients reported at least a 50% reduction in pain severity, and more than 50% reported reduction in opioid use. Minor complications included headache, asthenia, dizziness, and muscle twitches. Major complications included infection, cerebrospinal fluid leak, pain at electrode sites, and system failure. Follow-up ranged from one week to one year. All studies were of low quality.

Conclusions:

There is insufficient evidence to evaluate the potential role of spinal cord stimulation for cancer-related pain control.

Limitations:

Limitations included few publications and low-quality research.

Nursing Implications:

Effectiveness of spinal cord stimulation for management of cancer-related pain cannot be determined. There is a need for high-quality research in this area.


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