Spinal Cord Stimulation Relieves “Failed Back” Pain

Failed back surgery syndrome (FBSS, sometimes called “failed back syndrome”) is characterized by persistent neuropathic pain and varying degrees of functional disability after spinal surgery. Spinal cord stimulation (SCS) involves a small implantable device that uses low level electrical energy to interfere with pain impulses. A multicenter study, to be published in the November 2007 edition of the journal Pain, evaluated the effectiveness of SCS to reduce pain and disability in an FBSS population. Patients with FBSS and predominant leg pain of neuropathic radicular origin (n = 100) were randomized to a 6 month course of spinal cord stimulation plus conventional medical management (SCS group) or to conventional medical management alone (CMM group).

The primary outcome measure was the achievement of 50% or greater pain relief in the legs. Additional outcome measures included improvements in back and leg pain, functional capacity, health-related quality of life, use of drug and nondrug pain therapy, level of patient satisfaction, incidence of complications, and adverse effects. All patients were followed up to 1 year; crossover after 6 months was allowed.

Results at 6 months showed that 48% of the SCS group versus only 9% of patients in the CMM group (p < 0.001) achieved the primary outcome. Compared with the CMM group, patients using the SCS protocol reported improved leg/back pain relief, quality of life, and functional capacity, plus greater treatment satisfaction (p </= 0.05 for all comparisons). During the second 6-month period, 5 SCS patients crossed to CMM, while 32 patients in the CMM group crossed to SCS. At 1 year, 32% had experienced some device-related complications.

Clinical Perspective: While a 50% reduction in pain is important for patients who suffer the pain of FBSS, the procedure requires multidisciplinary care and careful patient selection. The researchers stated that SCS along with CMM for suitable candidates can provide improved pain relief and quality of life compared with CMM alone.

Reference: Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicenter randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007(Nov);132(1-2):179-188. Also see the editorial on SCS in the same issue of Pain (Turner JA, Deyo RA, Loeser JD. pp 10-11).

Pain Treatment Topics is produced by Stewart B. Leavitt, PhD, Ltd.;
Glenview, Illinois, USA. © type=text/javascript> </SCRIPT> 2005-2007, All rights reserved