Skip navigation
Acute Pain | Chronic Pain | General

Spinal cord stimulation for back pain

Clinical bottom line:

Evidence for spinal cord stimulation is still limited. Existing data are likely to be biased because of lack of randomisation and blinding. No conclusions can be drawn yet on the efficacy of spinal cord stimulation.


Spinal cord stimulation for chronic pain, like transcutaneous electrical nerve stimulation (TENS), is based on the gate control theory of pain. Surgically implanted electrodes, usually over the dorsal columns, are stimulated to activate pain inhibitory mechanisms. The number and type of electrodes implanted, and the type of stimulation received, are very variable. Implantation can be at open laminectomy, or may be percutaneous. The neurophysiology is unclear.

Systematic review

Turner JA, Loeser JD, Bell,KG. Spinal cord stimulation for chronic low back pain; a systematic literature synthesis. Neurosurgery. 1995; 37: 1088-1096.

Inclusion criteria were studies of epidural stimulation, dorsal column stimulation or spinal cord stimulation; chronic, intractable or low back pain or failed back surgery.

Reviewers extracted data on pain relief and where possible extracted numbers of patients with greater than 50% pain relief at follow-up periods.

Findings

Most studies reported on percutaneous electrode implant with single-channel stimulators. All included studies were case series, and 82% of them did not have planned study protocols. Few studies defined patient inclusion/exclusion criteria, and source of follow-up data was unclear.

Twenty-nine studies had at least 50% pain relief as an outcome. Across these studies the mean (probably unweighted, but not stated) was 59% of patients achieving this outcome at some follow-up point, with a range of 15% to 100%. At one year, 14 studies reported a mean of 62% success (range 15% to 100%). At two years, five trials reported a mean of 64% success (range 55% to 74%). At five years, three studies reported a mean of 53% success (range 50% to 55%). At ten years, one study reported 35% success.

Adverse effects

In 13 studies there was at least one complication in 42% of patients (range 20% to 75%). These were predominantly stimulator or electrode problems (mean 30% and 24% respectively, range 0% to 75%). Infection was less common, occurring in 5% of patients in the 20 trials reporting this (range 0% to 12%). Most complications appeared to be minor.

Further References

A single trial on spinal cord stimulation for diabetic peripheral neuropathy: Tesfaye S, Watt J, Benbow SJ, Pang KA, Miles J, MacFarlane IA. Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy. Lancet 1996; 348:1698-701.

Related topics