TY - JOUR
T1 - Spinal cord stimulation for failed back surgery syndrome
T2 - Outcomes in a workers' compensation setting
AU - Turner, Judith A.
AU - Hollingworth, William
AU - Comstock, Bryan A.
AU - Deyo, Richard A.
N1 - Funding Information:
This study was funded by Contract K311 from the Washington State Department of Labor and Industries . Support for data analyses was provided in part by Grant UL1RR025014 from the National Institutes of Health National Center for Research Resources to the University of Washington Center for Biomedical Statistics . The authors thank John Loeser, MD, for advice regarding the study design, SCS patient inclusion criteria, and abstraction and reporting of information concerning adverse events. We also thank Kelley Chaddock, Catherine Farr, Jeremy Gluck, Laura Henderson, Brook Martin, LaVonda McCandless, Deana Rich, and Blaine Robbins for help with the data collection and management. The authors have no conflicts of interest related to this research.
PY - 2010/1
Y1 - 2010/1
N2 - Questions remain concerning effectiveness and risks of spinal cord stimulation (SCS) for chronic back and leg pain after spine surgery ("failed back surgery syndrome" [FBSS]). This prospective, population-based controlled cohort study evaluated outcomes of workers' compensation recipients with FBSS who received at least a trial of SCS (SCS group, n = 51) versus those who (1) were evaluated at a multidisciplinary pain clinic and did not receive SCS (Pain Clinic, n = 39) or (2) received neither SCS nor pain clinic evaluation (Usual Care, n = 68). Patients completed measures of pain, function, medication use, and work status at baseline and 6, 12, and 24 months later. We also examined work time loss compensation over 24 months. Few (<10%) patients in any group achieved success at any follow-up on the composite primary outcome encompassing less than daily opioid use and improvement in leg pain and function. At 6 months, the SCS group showed modestly greater improvement in leg pain and function, but with higher rates of daily opioid use. These differences disappeared by 12 months. Patients who received a permanent spinal cord stimulator did not differ from patients who received some pain clinic treatment on the primary outcome at any follow-up (<10% successful in each group at each follow-up) and 19% had them removed within 18 months. Both trial and permanent SCS were associated with adverse events. In sum, we found no evidence for greater effectiveness of SCS versus alternative treatments in this patient population after 6 months.
AB - Questions remain concerning effectiveness and risks of spinal cord stimulation (SCS) for chronic back and leg pain after spine surgery ("failed back surgery syndrome" [FBSS]). This prospective, population-based controlled cohort study evaluated outcomes of workers' compensation recipients with FBSS who received at least a trial of SCS (SCS group, n = 51) versus those who (1) were evaluated at a multidisciplinary pain clinic and did not receive SCS (Pain Clinic, n = 39) or (2) received neither SCS nor pain clinic evaluation (Usual Care, n = 68). Patients completed measures of pain, function, medication use, and work status at baseline and 6, 12, and 24 months later. We also examined work time loss compensation over 24 months. Few (<10%) patients in any group achieved success at any follow-up on the composite primary outcome encompassing less than daily opioid use and improvement in leg pain and function. At 6 months, the SCS group showed modestly greater improvement in leg pain and function, but with higher rates of daily opioid use. These differences disappeared by 12 months. Patients who received a permanent spinal cord stimulator did not differ from patients who received some pain clinic treatment on the primary outcome at any follow-up (<10% successful in each group at each follow-up) and 19% had them removed within 18 months. Both trial and permanent SCS were associated with adverse events. In sum, we found no evidence for greater effectiveness of SCS versus alternative treatments in this patient population after 6 months.
KW - Effectiveness
KW - Failed back surgery syndrome
KW - Pragmatic study
KW - Prospective controlled study
KW - Spinal cord stimulation
KW - Workers' compensation
UR - http://www.scopus.com/inward/record.url?scp=72149083295&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=72149083295&partnerID=8YFLogxK
U2 - 10.1016/j.pain.2009.08.014
DO - 10.1016/j.pain.2009.08.014
M3 - Article
C2 - 19875232
AN - SCOPUS:72149083295
SN - 0304-3959
VL - 148
SP - 14
EP - 25
JO - Pain
JF - Pain
IS - 1
ER -