Erasmus Medical Center, Rotterdam, the Netherlands.
IQVIA, Athens, Greece.
JAMA Netw Open. 2024 Nov 4;7(11):e2444608. doi: 10.1001/jamanetworkopen.2024.44608.
Chronic back and lower extremity pain is one of the leading causes of disability worldwide. Spinal cord stimulation (SCS) aims to improve symptoms and quality of life.
To evaluate the efficacy of SCS therapies compared with conventional medical management (CMM).
MEDLINE, Embase, and Cochrane Library were systematically searched from inception to September 2, 2022.
Selected studies were randomized clinical trials comparing SCS therapies with sham (placebo) and/or CMM or standard treatments for adults with chronic back or leg pain who had not previously used SCS.
Evidence synthesis estimated odds ratios (ORs) and mean differences (MDs) and their associated credible intervals (CrI) through bayesian network meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for network meta-analyses was followed.
The primary outcomes were pain-related end points, including pain intensity (measured by visual analog scale) and proportion of patients achieving at least 50% pain relief (responder rate) in the back or leg. Quality of life (measured by EQ-5D index score) and functional disability (measured by the Oswestry Disability Index score) were also considered.
A total of 13 studies of 1561 patients were included in the network meta-analysis comparing conventional and novel SCS therapies with CMM across the 6 outcomes of interest at the 6-month follow-up. Both conventional and novel SCS therapies were associated with superior efficacy compared with CMM in responder rates in back (conventional SCS: OR, 3.00; 95% CrI, 1.49 to 6.72; novel SCS: OR, 8.76; 95% CrI, 3.84 to 22.31), pain intensity in back (conventional SCS: MD, -1.17; 95% CrI, -1.64 to -0.70; novel SCS: MD, -2.34; 95% CrI, -2.96 to -1.73), pain intensity in leg (conventional SCS: MD, -2.89; 95% CrI, -4.03 to -1.81; novel SCS: MD, -4.01; 95% CrI, -5.31 to -2.75), and EQ-5D index score (conventional SCS: MD, 0.15; 95% CrI, 0.09 to 0.21; novel SCS: MD, 0.17; 95% CrI, 0.13 to 0.21). For functional disability, conventional SCS was superior to CMM (MD, -7.10; 95% CrI, -10.91 to -3.36). No statistically significant differences were observed for other comparisons.
This systematic review and network meta-analysis found that SCS therapies for treatment of chronic pain in back and/or lower extremities were associated with greater improvements in pain compared with CMM. These findings highlight the potential of SCS therapies as an effective and valuable option in chronic pain management.
慢性腰背和下肢疼痛是全球导致残疾的主要原因之一。脊髓刺激（SCS）旨在改善症状和生活质量。
评估 SCS 疗法与常规医学管理（CMM）相比的疗效。
从开始到 2022 年 9 月 2 日，系统地检索了 MEDLINE、Embase 和 Cochrane 图书馆。
入选的研究为比较 SCS 治疗与假（安慰剂）和/或 CMM 或标准治疗慢性腰背或腿部疼痛且以前未使用过 SCS 的成年人的随机临床试验。
通过贝叶斯网络荟萃分析估计比值比（ORs）和平均差异（MDs）及其相关可信区间（CrI）。遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南进行网络荟萃分析。
主要结局是与疼痛相关的终点，包括疼痛强度（用视觉模拟量表测量）和至少 50%疼痛缓解的患者比例（反应率）在背部或腿部。生活质量（用 EQ-5D 指数评分测量）和功能障碍（用 Oswestry 残疾指数评分测量）也被考虑在内。
共有 13 项研究共纳入 1561 名患者，对常规和新型 SCS 疗法与 CMM 在 6 个月随访时 6 个感兴趣结局的比较进行了网络荟萃分析。常规和新型 SCS 疗法在反应率方面均优于 CMM，在背部（常规 SCS：OR，3.00；95%CrI，1.49 至 6.72；新型 SCS：OR，8.76；95%CrI，3.84 至 22.31）、背部疼痛强度（常规 SCS：MD，-1.17；95%CrI，-1.64 至-0.70；新型 SCS：MD，-2.34；95%CrI，-2.96 至-1.73）、腿部疼痛强度（常规 SCS：MD，-2.89；95%CrI，-4.03 至-1.81；新型 SCS：MD，-4.01；95%CrI，-5.31 至-2.75）和 EQ-5D 指数评分（常规 SCS：MD，0.15；95%CrI，0.09 至 0.21；新型 SCS：MD，0.17；95%CrI，0.13 至 0.21）方面均有显著改善。对于功能障碍，常规 SCS 优于 CMM（MD，-7.10；95%CrI，-10.91 至-3.36）。其他比较没有观察到统计学上的显著差异。
本系统评价和网络荟萃分析发现，SCS 疗法治疗背部和/或下肢慢性疼痛与 CMM 相比，疼痛改善更显著。这些发现强调了 SCS 疗法作为慢性疼痛管理中一种有效和有价值的选择的潜力。
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