Department of Physical Medicine and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY.
Pain Physician. 2022 Nov;25(8):521-530.
Complex Regional Pain Syndrome (CRPS) is a chronic debilitating neuropathic pain condition characterized by autonomic and inflammatory features that typically occurs after a traumatic event. Spinal cord stimulation (SCS) has been shown to be effective in the treatment of chronic CRPS refractory to conventional treatment modalities. The collective evidence of novel parameters of SCS for treating CRPS has not been characterized extensively.
To provide evidence for the use of SCS to treat CRPS and characterize the additional benefits of various SCS waveforms.
Systematic Review and Meta-analysis.
PubMed, Embase and CINHLA were screened for all randomized controlled trials (RCT) comparing SCS parameters for the treatment of CRPS.
Four RCTs were identified that included SCS as a treatment arm for CRPS. Of these, one study compared low frequency tonic SCS (LF-SCS) versus conventional physical therapy, 2 studies compared placebo/sham SCS with LF-SCS and a multitude of waveforms, and one study compared LF-SCS with high-frequency SCS (HF-SCS). Two of the studies were rated as having a low risk of bias, one study was rated as having some concerns for bias, while the final study was rated as having a high risk of bias. A meta-analysis of 4 studies comparing conventional therapy/placebo SCS stimulation against LF-SCS revealed increased benefit of LF-SCS in pain reduction up to a month (mean difference [MD] = -1.17 points; 95% CI = -1.61 to -0.73; P < 0.001, I2 = 42%). Another meta-analysis of 2 studies showed that LF-SCS results in higher global perceived effect scores relative to conventional therapy/placebo SCS stimulation (MD = 1.58; 95% CI = 1.00 to 2.15; P < 0.001, I2 = 0%).
A pooled analysis using different designs for RCTs was conducted. Some studies folded in multiple neuropathic pain pathologies in addition to CRPS. One study was at a high risk for bias in at least one domain.
LF-SCS is superior to conventional therapy/placebo SCS stimulation. However, more evidence is required to demonstrate that novel SCS parameters are superior to LF-SCS in improving pain scores and functional outcomes.
复杂性区域疼痛综合征（CRPS）是一种慢性衰弱性神经病理性疼痛疾病，其特征为自主和炎症特征，通常发生在创伤事件之后。脊髓刺激（SCS）已被证明对慢性 CRPS 无效的常规治疗方式有效。尚未广泛描述用于治疗 CRPS 的 SCS 新参数的综合证据。
提供使用 SCS 治疗 CRPS 的证据，并描述各种 SCS 波形的额外益处。
系统评价和荟萃分析。
在 PubMed、Embase 和 CINHLA 中筛选所有比较 SCS 参数治疗 CRPS 的随机对照试验（RCT）。
确定了 4 项 RCT，其中 SCS 作为 CRPS 的一种治疗手段。其中，一项研究比较了低频持续刺激 SCS（LF-SCS）与常规物理治疗，2 项研究比较了安慰剂/假 SCS 与 LF-SCS 和多种波形，1 项研究比较了 LF-SCS 与高频 SCS（HF-SCS）。其中 2 项研究被评为低偏倚风险，1 项研究被评为存在一些偏倚问题，而最后 1 项研究被评为高偏倚风险。对 4 项比较常规治疗/安慰剂 SCS 刺激与 LF-SCS 的研究进行荟萃分析显示，LF-SCS 在减轻疼痛方面的益处更大，可达 1 个月（平均差异 [MD] = -1.17 分；95%CI = -1.61 至 -0.73；P < 0.001，I2 = 42%）。另一项对 2 项研究的荟萃分析表明，LF-SCS 导致的总体感知效果评分高于常规治疗/安慰剂 SCS 刺激（MD = 1.58；95%CI = 1.00 至 2.15；P < 0.001，I2 = 0%）。
对使用不同设计的 RCT 进行了汇总分析。一些研究除了 CRPS 之外还合并了多种神经病理性疼痛病理。一项研究在至少一个领域存在高偏倚风险。
LF-SCS 优于常规治疗/安慰剂 SCS 刺激。然而，需要更多证据证明新型 SCS 参数在改善疼痛评分和功能结局方面优于 LF-SCS。
