Med Student Medical News about Stimulation Failed Back Surgery Syndrome Spinal Cord Workers' Compensation

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Spinal cord stimulation for failed back surgery syndrome: Outcomes in a workers' compensation setting
Pain, 11/02/09

Turner JA et al. – The authors found no evidence for greater effectiveness of spinal cord stimulation (SCS) versus alternative treatments in this patient population after 6 months.

Methods

This prospective, population–based controlled cohort study evaluated outcomes of workers’ compensation recipients with FBSS (“failed back surgery syndrome”) 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 24months later.
The authors also examined work time loss compensation over 24months.

Results

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 12months.
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 18months.
Both trial and permanent SCS were associated with adverse events.