Mark Hofmeister1,2, Ally Memedovich1,2, Sage Brown1,2, Manik Saini3, Laura E Dowsett1,2, Diane L Lorenzetti1,2,4, Tamara L McCarron1,2, Gail MacKean1,2, Fiona Clement1,2. 1. The Department of Community Health Sciences, University of Calgary, Teaching Research and Wellness Building, Calgary, Alberta, Canada. 2. O'Brien Institute for Public Health, Teaching Research and Wellness Building, Calgary, Alberta, Canada. 3. Research and Innovation Division, British Columbia Ministry of Health, Victoria, British Columbia, Canada. 4. Health Sciences Library, University of Calgary, Calgary, Alberta, Canada.
Abstract
OBJECTIVES: To describe the state of the literature for clinical effectiveness of neurostimulation used for the management of chronic pain. METHODS: A systematic review of spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), peripheral nerve field stimulation (PNFS), and supraorbital transcutaneous electrical nerve stimulation in patients with cancer and noncancer chronic pain was conducted. MEDLINE, Embase, CINAHL, and the Cochrane CENTRAL Register of Controlled Trials were searched, using terms like "electrical stimulation therapy" and "pain management." Direction of effect, consistency across studies, and strength of evidence for effects of neurostimulation on chronic pain were narratively synthesized. RESULTS: A total of 15 randomized controlled trials (RCTs) examining SCS, 7 RCTs examining PNS/PNFS, and 1 nonrandomized trial examining supraorbital transcutaneous electrical nerve stimulation (TENS) were included. In nine SCS studies, neurostimulation had positive effects on pain. In three studies, neurostimulation did not significantly reduce pain. For PNS/PNFS, five studies found improvements in pain offered by neurostimulation; pain outcomes were not reported in two studies. In the TENS study, neurostimulation reduced headaches per month and medication consumption. Overall, 21 studies were of low or unclear risk of bias, 4 were high risk of bias, and the TENS study was not appropriate for assessment using the Cochrane Risk of Bias tool. CONCLUSIONS: A robust body of evidence examining SCS and PNS was identified. Only one study for PNFS and TENS was identified; both reported pain reductions. Generally, neurostimulation improved pain control. Future studies should examine the effectiveness of neurostimulation offered early in the trajectory of chronic pain.
OBJECTIVES: To describe the state of the literature for clinical effectiveness of neurostimulation used for the management of chronic pain. METHODS: A systematic review of spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), peripheral nerve field stimulation (PNFS), and supraorbital transcutaneous electrical nerve stimulation in patients with cancer and noncancer chronic pain was conducted. MEDLINE, Embase, CINAHL, and the Cochrane CENTRAL Register of Controlled Trials were searched, using terms like "electrical stimulation therapy" and "pain management." Direction of effect, consistency across studies, and strength of evidence for effects of neurostimulation on chronic pain were narratively synthesized. RESULTS: A total of 15 randomized controlled trials (RCTs) examining SCS, 7 RCTs examining PNS/PNFS, and 1 nonrandomized trial examining supraorbital transcutaneous electrical nerve stimulation (TENS) were included. In nine SCS studies, neurostimulation had positive effects on pain. In three studies, neurostimulation did not significantly reduce pain. For PNS/PNFS, five studies found improvements in pain offered by neurostimulation; pain outcomes were not reported in two studies. In the TENS study, neurostimulation reduced headaches per month and medication consumption. Overall, 21 studies were of low or unclear risk of bias, 4 were high risk of bias, and the TENS study was not appropriate for assessment using the Cochrane Risk of Bias tool. CONCLUSIONS: A robust body of evidence examining SCS and PNS was identified. Only one study for PNFS and TENS was identified; both reported pain reductions. Generally, neurostimulation improved pain control. Future studies should examine the effectiveness of neurostimulation offered early in the trajectory of chronic pain.
Authors: James J Mahoney; Colleen A Hanlon; Patrick J Marshalek; Ali R Rezai; Lothar Krinke Journal: J Neurol Sci Date: 2020-09-20 Impact factor: 3.181
Authors: Nathaniel Katz; Robert H Dworkin; Richard North; Simon Thomson; Sam Eldabe; Salim M Hayek; Brian H Kopell; John Markman; Ali Rezai; Rod S Taylor; Dennis C Turk; Eric Buchser; Howard Fields; Gregory Fiore; McKenzie Ferguson; Jennifer Gewandter; Chris Hilker; Roshini Jain; Angela Leitner; John Loeser; Ewan McNicol; Turo Nurmikko; Jane Shipley; Rahul Singh; Andrea Trescot; Robert van Dongen; Lalit Venkatesan Journal: Pain Date: 2021-07-01 Impact factor: 6.961