NEW ORLEANS, Louisiana—Spinal cord stimulation (SCS) can significantly reduce axial low back pain (LBP), even in patients with failed back surgery syndrome (FBSS), and should be more widely used, according to researchers at the American Academy of Pain Medicine 23rd Annual Meeting.1 Todd Gross, PhD, reporting for the Axial Low Back Pain Study Group, said that subjects reported an average 40% decrease in pain with SCS. Dr. Gross is at Advanced Bionics, in Valencia, California.

Investigators at 24 centers tested Advanced Bionics' Precisionâ„¢ SCS system in 259 subjects with a primary complaint of axial LBP. Subjects were implanted with either one or two epidural percutaneous SCS leads, used with an external trial stimulator. After a 5-to-10 day trial, 172 of 226 subjects (76.1%) reported a significant reduction in pain and were eligible for implantation of a permanent SCS system. Nearly all of these patients (159 of 172 [92.4%]) opted for permanent implants.

After the permanent SCS system was activated, the researchers assessed outcomes at baseline and at 3, 6, and 12 months. The assessments included pain, disability (Oswestry disability scale), quality of life (EQ5D), medical satisfaction, the Battery for Health Improvement II, the Brief Battery for Health Improvement, and health care utilization, including use of pain medication.

"Self-reported pain ratings (0 to 10 scale) dropped significantly from baseline following the temporary stimulation trial (6.6 vs 3.9, P <.0001). Subjects reported, on average, a 40% decrease," Dr. Gross said. "The responder rate was unexpectedly high, given the challenges inherent to treating a long-term disabled and refractory axial back pain population." He noted that preliminary data suggest that pain reduction at similar levels is maintained with long-term use.

Richard B. North, MD, professor of neurosurgery, anesthesiology, and critical care medicine, at The Johns Hopkins Hospital, in Baltimore, Maryland, told CIAOMed that the 70% response rate in this study is similar to results he has seen in trials with similar devices from other manufacturers.

"Spinal cord stimulation should probably be considered more often for treating axial LBP, particularly as it is amenable to a simple percutaneous trial," Dr. North said.

Dr. North's group has studied SCS in patients with persistent or recurrent radicular pain after lumbosacral spine surgery. They found that SCS was significantly more effective than reoperation at relieving pain and reducing the use of opiate analgesics.2

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Reference

1. Thacker J, Gross T, Foster A. A multi-center study evaluating the efficacy of spinal cord stimulation (SCS) for axial low back pain. Presented at: The American Academy of Pain Medicine 23rd Annual Meeting; February 7-10, 2007; New Orleans, LA. Abstract 114.
2. North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56:98-106.