Spinal cord stimulation for complex regional pain syndrome: an evidence-based medicine review of the literature.
OBJECTIVE
The purpose of this investigation is to assess the evidence for efficacy of SCS in the management of pain in patients with CRPS.


METHODS



METHODS
Electronic databases such as Medline and Cochrane Library were queried using key words such as "spinal cord stimulation," "reflex sympathetic dystrophy (RSD)," and "complex regional pain syndrome (CRPS)."


METHODS
Relevant published randomized controlled trials (RCT), cohort studies, case-control studies, case series, and case reports that described SCS as the primary treatment modality for patients with CRPS were eligible for inclusion.


METHODS
Data extracted from qualified studies were summarized in sections of methodology, demographics, SCS equipment, primary and secondary outcomes, and complications.


RESULTS
Thirteen studies using the primary search strategy and 7 studies from their reference lists were considered. Five of these 20 studies were discarded. One RCT, 2 prospective observational, and 12 retrospective observational studies were eventually considered. The methodological quality of all studies was poor except for the single RCT study.


CONCLUSIONS
Although limited in quality and quantity, available evidence from the examined literature suggests that SCS is effective in the management of pain in patients with CRPS (grade B/C). Clinically useful information extracted from the available studies is very limited in guiding clinicians in the rational use of SCS for pain management in CRPS patients. Future attempts to investigate the efficacy of SCS in CRPS patients should involve methodologically robust designs such as randomized studies that have sufficient power.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland 21287, USA.
Theodore S
TS
Grabow
Prabhav K
PK
Tella
Srinivasa N
SN
Raja
D020918:Complex Regional Pain Syndromes / Q000453:epidemiology / Q000628:therapy*; D003625:Data Collection; D003710:Demography; D004599:Electric Stimulation Therapy; D015340:Epidemiologic Research Design; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D009862:Online Systems; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D012019:Reflex Sympathetic Dystrophy; D012196:Review Literature as Topic; D013116:Spinal Cord