Spine
Meta-Analysis: Spinal Cord Stimulation May Be Effective for Chronic Back and Leg Pain
15 Nov, 2024 | 13:43h | UTCBackground: Chronic back and leg pain causes significant disability worldwide. Spinal cord stimulation (SCS) offers treatment for patients unresponsive to conventional medical management (CMM). The comparative efficacy of conventional and novel SCS forms versus CMM is debated, requiring thorough evaluation.
Objective: To evaluate the efficacy of conventional and novel SCS therapies compared with CMM in adults with chronic back or leg pain who had not previously used SCS.
Methods: A systematic review and Bayesian network meta-analysis per PRISMA guidelines were performed. MEDLINE, Embase, and Cochrane Library were searched up to September 2, 2022. Thirteen RCTs with 1,561 patients were included. Interventions were conventional SCS, novel SCS modalities (e.g., high-frequency, burst stimulation), and CMM. Primary outcomes were pain intensity (visual analog scale) and responder rates (≥50% pain relief) in back or leg. Secondary outcomes were quality of life (EQ-5D index) and functional disability (Oswestry Disability Index).
Results: At 6 months, both conventional and novel SCS were superior to CMM in five of six outcomes. For back pain responder rates, conventional SCS had an OR of 3.00 (95% CrI, 1.49–6.72) and novel SCS had an OR of 8.76 (95% CrI, 3.84–22.31) versus CMM. Pain intensity in the back decreased significantly with conventional SCS (MD, –1.17; 95% CrI, –1.64 to –0.70) and novel SCS (MD, –2.34; 95% CrI, –2.96 to –1.73). Leg pain intensity also decreased significantly with conventional SCS (MD, –2.89; 95% CrI, –4.03 to –1.81) and novel SCS (MD, –4.01; 95% CrI, –5.31 to –2.75) compared to CMM. Quality of life improved with both SCS therapies (conventional SCS MD, 0.15; 95% CrI, 0.09–0.21; novel SCS MD, 0.17; 95% CrI, 0.13–0.21). Functional disability improved significantly with conventional SCS (MD, –7.10; 95% CrI, –10.91 to –3.36).
Conclusions: Both conventional and novel SCS therapies are associated with significant improvements in pain relief, quality of life, and functional ability compared with CMM in patients with chronic back and leg pain at 6 months.
Implications for Practice: The results support integrating SCS therapies into clinical practice for patients with chronic back and leg pain unresponsive to CMM.
Study Strengths and Limitations: Strengths include inclusion of recent RCTs and use of Bayesian network meta-analysis, allowing comprehensive evidence synthesis with both direct and indirect comparisons, enhancing reliability. Limitations involve potential biases due to challenges in blinding participants and assessors, as patients can perceive whether a device is active. Heterogeneity among studies in patient populations and interventions may affect generalizability. Inability to include long-term efficacy data due to crossover in many trials limits understanding of sustained outcomes.
Future Research: Long-term RCTs are needed to assess sustained efficacy and safety of SCS therapies. Future studies should compare different SCS modalities directly and identify patient subgroups most likely to benefit.
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Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050
2 Jun, 2023 | 12:34h | UTCEditorial: The global epidemic of low back pain – The Lancet Rheumatology
News Releases:
Commentary on Twitter
NEW—GBD 2021 data published in @TheLancetRheum finds low back pain is the leading cause of disability globally. #LowBackPain affects 619 million individuals (1 out of every 13 people). More women across all age groups suffered from low back pain than men.https://t.co/A2RoU9hn9p pic.twitter.com/vhXwcVh1e7
— Institute for Health Metrics and Evaluation (IHME) (@IHME_UW) May 22, 2023
RCT | Investigational 4-Antigen Staphylococcus aureus vaccine fails to prevent infections in spinal surgery
12 May, 2023 | 13:12h | UTC
Commentary on Twitter
Efficacy of a 4-Antigen Staphylococcus aureus Vaccine in Spinal Surgery: The STRIVE Randomized Clinical Trial
✅ Just Accepted
🔓 Open Access
🔗 https://t.co/eFVufc7rzi pic.twitter.com/XdylTWa66v— Clinical Infectious Diseases (@CIDJournal) May 3, 2023
RCT | Cognitive functional therapy with or without biofeedback outperforms usual care for chronic low back pain relief
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News Release: Fresh hope for Australians living with chronic back pain – Curtin University
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10 May, 2023 | 15:44h | UTC
ESTES recommendation on thoracolumbar spine fractures
10 May, 2023 | 15:40h | UTC
Treating long-lasting low back pain without surgery: the latest evidence
4 May, 2023 | 13:40h | UTCTreating long-lasting low back pain without surgery: the latest evidence – Evidently Cochrane
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26 Apr, 2023 | 13:53h | UTC
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25 Apr, 2023 | 14:39h | UTCEditorial: Early surgery for sciatica – The BMJ
News Release: Surgery for sciatica reduces leg pain and disability, but benefits are short-lived – University of Oxford
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Very low to low certainty evidence suggests that discectomy was superior to non-surgical treatment or epidural steroid injections in reducing leg pain and disability in people with sciatica with a surgical indication, but the benefits reduced over timehttps://t.co/kHL2HBNscF
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RCT | Stereotactic radiosurgery vs. conventional radiotherapy for localized vertebral metastases of the spine
24 Apr, 2023 | 13:37h | UTCStereotactic Radiosurgery vs Conventional Radiotherapy for Localized Vertebral Metastases of the Spine: Phase 3 Results of NRG Oncology/RTOG 0631 Randomized Clinical Trial – JAMA Oncology (link to abstract – $ for full-text)
Audio interview: Radiosurgery of Spine Metastasis—NRG/RTOG 0631 RCT Final Results – JAMA
Commentary on Twitter
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Low back pain of disc, sacroiliac joint, or facet joint origin: a diagnostic accuracy systematic review
12 Apr, 2023 | 13:17h | UTC
Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews
11 Apr, 2023 | 14:39h | UTCRelated:
SR | Nonopioid pharmacological management of acute low back pain
M-A | Limited evidence for analgesic effectiveness in acute low back pain treatment
M-A: Effectiveness of treatments for acute and subacute mechanical non-specific low back pain
Guideline Interventions for the management of acute and chronic low back pain.
M-A: Little benefit from muscle relaxants for adults with non-specific low back pain.
SR | Nonopioid pharmacological management of acute low back pain
31 Mar, 2023 | 13:27h | UTC
RCT | Drain usage may increase the length of hospital stay following lumbar arthrodesis
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M-A | Limited evidence for analgesic effectiveness in acute low back pain treatment
29 Mar, 2023 | 13:32h | UTCSummary: The objective of this systematic review and network meta-analysis was to assess the effectiveness and safety of various analgesic medicines for treating acute non-specific low back pain. After examining 98 randomized controlled trials with over 15,000 participants, the study found that the quality of evidence for the effectiveness and safety of these medications is low or very low.
Some analgesic medicines showed potential in reducing pain intensity, but the evidence was limited due to trial risk of bias and imprecision in effect estimates. Furthermore, certain medications might increase the risk of adverse events during treatment, with evidence ranging from moderate to very low confidence.
Given the lack of high-quality evidence, clinicians and patients are advised to be cautious when using analgesic medicines for acute non-specific low back pain. More robust head-to-head comparison trials are needed to provide clearer guidance on the best course of treatment.
News Release: Study finds “considerable uncertainty” around effectiveness and safety of analgesics for low back pain – BMJ Newsroom
Commentary from the author on Twitter (thread – click for more)
Out today in @bmj_latest.
We found “considerable uncertainty” around the effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain.
Available at https://t.co/PeOmEOeJyJ
Thread 🧵 pic.twitter.com/T8YDNGhhME
— Michael Wewege, PhD (@mawewege) March 22, 2023
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Review | MRI image features with an evident relation to low back pain
15 Mar, 2023 | 15:01h | UTC
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9 Mar, 2023 | 14:15h | UTC
SR | Spinal cord stimulation for low back pain provides no sustained clinical benefits compared to placebo
9 Mar, 2023 | 14:12h | UTCSummary: Spinal cord stimulation (SCS) is a surgical procedure used to treat persistent low back pain by sending electrical signals via implanted electrodes into the spinal cord. The review included 13 studies (randomized controlled trials and cross‐over trials) with 699 participants.
Most of the studies were focused on short-term effects (less than one month), but the review found it is uncertain whether spinal cord stimulation can improve outcomes in the immediate term compared with placebo. At six months, SCS probably does not improve back or leg pain, function, or quality of life compared with placebo, with moderate certainty of evidence. Adverse events were also reported, including infections, neurological damage, and lead migration requiring repeated surgery.
The review concluded that the data does not support the use of SCS to manage low back pain outside a clinical trial. Current evidence suggests SCS probably does not have sustained clinical benefits that would outweigh the costs and risks of this surgical intervention.
Article: Spinal cord stimulation for low back pain – Cochrane Library
Summary: Spinal cord stimulation for low back pain – Cochrane Library
Commentary from the author on Twitter
Our Cochrane review on spinal cord stimulators for #backpain out today.
Bottom line:
-Mod certainty evidence of no benefit vs placebo in medium term
-Uncertain if benefit on pain in immediate term
-Adverse events (infection, re-operation) commonhttps://t.co/lNJQeN96Zs— Adrian Traeger (@adrian_traeger) March 7, 2023
Chronic low back pain: a narrative review of recent international guidelines for diagnosis and conservative treatment
27 Feb, 2023 | 12:46h | UTC
SR | Nonopioid pharmacological management of acute low back pain
27 Feb, 2023 | 12:42h | UTCCommentary: Which Meds are Best for Acute Low Back Pain? – RheumNow
Related:
M-A: Effectiveness of treatments for acute and subacute mechanical non-specific low back pain
Guideline Interventions for the management of acute and chronic low back pain.
M-A: Little benefit from muscle relaxants for adults with non-specific low back pain.
Consensus Paper | Acute lower extremity fracture management in chronic spinal cord injury
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