Advancing the Science

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October 24, 2019

New research shows spinal stimulation may work better than medication for long-term pain reduction

By Elizabeth Zimmermann

In a recent study, a team of Mayo Clinic researchers examined the effectiveness of spinal stimulation for pain control, compared to medical therapy or multiple surgeries for patients with long-term spine or limb pain.

They found spinal stimulation was significantly more likely to reduce pain than medication for patients with intractable pain. Their findings were published in Mayo Clinic Proceedings.

“Intractable pain, or refractory pain is pain that occurs when multiple evidence‐based treatments have been tried and the patient has not reached treatment goals,” says study first author Tim Lamer, M.D., an anesthesiologist, pain management, and spine care specialist at Mayo Clinic. “Typically this means they have not achieved satisfactory pain reduction and/or functional improvement.”

According to the National Institutes of Health, “almost 11 million U.S. adults have ‘High Impact Chronic Pain,’ that is, pain that has lasted 3 months or longer and is accompanied by at least one major activity restriction, such as being unable to work outside the home, go to school, or do household chores.”

Because back and/or limb problems are the commonest pain complaints, Dr. Lamer says it made sense to try and determine the most effective ways to help patients.

The research

In this meta-analysis (analysis of a collection of relevant studies), the team study used a random-effects model to compare any type of spinal stimulation to medical therapy. They also compared newer stimulation technologies such as high frequency spinal cord stimulation and dorsal root ganglion stimulation to conventional spinal stimulation.

“This kind of research (random-effects) incorporates uncertainties due to differences between the settings of the studies, like patient or provider characteristics,” says senior author M. Hassan Murad, M.D., a preventive medicine physician and health services researcher at Mayo Clinic. “It’s a common tool in meta-analyses.”

After conducting a search of peer-reviewed publications, they found 17 manuscripts, from 12 clinical trials comparing medical therapy or repeated surgeries to either conventional or new spinal stimulation for pain control.

Physical therapy doctor discusses spine model with patient.

The researchers also employed the indirect comparison technique. “If studies compare treatments A vs B, and B vs C, we can indirectly compare A and C,” explains Dr. Murad.

“Because we found no studies comparing new spinal stimulation technologies to medical therapy, we needed to indirectly compare them.”

Although there are some limitations, Dr. Murad says this kind of research can help lead to the best possible outcomes for patients.

“The estimates we provide should be used to support shared-decision making,” he says. “Other factors, such as patient’s values and preferences, feasibility and accessibility of treatment also need to be considered when making treatment decisions.”

Publishing the meta-analysis in and of itself may prove to be helpful for patients, as it calls attention to the option of spinal stimulation for pain control.

“Many non-pain specialists are not generally aware of spinal cord stimulation,” says Dr. Lamer, “and how effective it can be for properly selected patients with difficult to manage chronic pain.”

He says that this includes patients with complex spinal pain syndromes, painful neuropathies including diabetic neuropathy, and post-traumatic pain syndromes such as complex regional pain syndrome.  

“Patients who are not responding to conventional conservative measures such as medications and physical therapy should be referred to a qualified interventional pain specialist to be evaluated for spinal cord stimulation candidacy.” 

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Dr. Murad leads knowledge synthesis research like this meta-analysis, in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. He also is the director of the Evidence-based Practice Center.

Related resources:

Implantable spinal cord stimulator (video news item)

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Tags: Center for the Science of Health Care Delivery, Evidence-based Practice Center, Findings, M. Hassan Murad, Mayo Clinic Proceedings, News, opioids, orthopedics, pain management, spinal cord stimulation, Tim Lamer

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