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Spinal cord stimulation for cancer-related pain in adults

  1. Peng Lihua1,
  2. Min Su1,*,
  3. Zhou Zejun1,
  4. Wei Ke1,
  5. Michael I Bennett2,†

Editorial Group: Cochrane Pain, Palliative and Supportive Care Group

Published Online: 28 FEB 2013

Assessed as up-to-date: 24 JAN 2013

DOI: 10.1002/14651858.CD009389.pub2


How to Cite

Lihua P, Su M, Zejun Z, Ke W, Bennett MI. Spinal cord stimulation for cancer-related pain in adults. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD009389. DOI: 10.1002/14651858.CD009389.pub2.

Author Information

  1. 1

    The First Affiliated Hospital, Chongqing Medical University, Department of Anaesthesia and Pain Medicine, Chongqing Municipanity, Chongqing Municipanity, China

  2. 2

    University of Leeds, Leeds Institute of Health Sciences, Leeds, UK

  1. Lancaster University, Institute for Health Research, Bowland Tower East Lancaster, LA1 4YT UK.

*Min Su, Department of Anaesthesia and Pain Medicine, The First Affiliated Hospital, Chongqing Medical University, No 1 Youyi Road, Yuanjiangang community, Yuzhong District, Chongqing Municipanity, Chongqing Municipanity, 400016, China. minsu89011068@yahoo.com.cn.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 28 FEB 2013

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Characteristics of included studies [ordered by study ID]
Meglio 1989

MethodsPart of a retrospective study to analyse 109 patients with chronic pain who underwent spinal cord stimulation, clinical efficacy was analysed in relation to the aetiology of pain.


ParticipantsFrom 1978-1986,109 participants were enrolled, 11 patients with cancer pain; 40 with vasculopathic pain, 19 with lower back pain; 15 with paraplegic pain; 9 with deafferentation pain,10 with post-herpetic pain.


InterventionsPercutaneous placement of the stimulator electrodes or positioned through a small laminectomy after a test period of 5 to 60 days, two kinds of stimulators were used: the first was a radiofrequency system; the second was programmable stimulators, which were programmed with a pulse width of 210 microseconds and a rate of 85 Hz,64 seconds on,1 to 4 minutes off, amplitude was at will to produce comfortable paraesthesia.


OutcomesReduction of visual analogue scale as percentage of analgesia (0% denotes no effect,100% denotes complete pain relief, a reduction of more than 50% of original pain was considered as responder); adverse events.


NotesNone


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskNo information was provided.

Allocation concealment (selection bias)High riskNo information was provided.

Blinding of participants and personnel (performance bias)
All outcomes
High riskNo information was provided.

Blinding of outcome assessment (detection bias)
All outcomes
High riskNo information was provided.

Incomplete outcome data (attrition bias)
All outcomes
High riskNo information was provided.

Selective reporting (reporting bias)High riskNo information was provided.

Other biasHigh riskNo information was provided.

Shimoji 1993

MethodsA survey of clinical results of using percutaneous epidural low-frequency spinal cord stimulation for chronic pain.


ParticipantsBetween 1970-1991, 454 patients with chronic pain received percutaneous epidural low-frequency spinal cord stimulation, 52 with carcinoma/sarcoma; 126 with post-herpetic neuralgia; 189 with causalgia; 12 with spinal trauma; 9 with SMON; 3 with tabes dorsalis; 8 with phantom pain; 14 with TAO/ASO; 9 with thalamic syndrome; 32 with other pain.


InterventionsAll patients received implantation of electrodes at sites of pain which connected to a stimulator that delivered saw-wave pulses (0.5ms in duration and 0.5-50 Hz in frequency). The frequency of stimulation was adjustable by the patient at between 1.6 and 8.0 Hz, the intensity being 0.5-5.0 V. The mode of stimulation was continuous in nine patients with cancer or occasional (3-12/day for 20-30 min) in 445 patients, depending on patients' complaints.


OutcomesDegree of pain relief as visual analogue scale, 50% of reduction was considered as pain relief; adverse events.


NotesNone


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskNo information was provided.

Allocation concealment (selection bias)High riskNo information was provided.

Blinding of participants and personnel (performance bias)
All outcomes
High riskNo information was provided.

Blinding of outcome assessment (detection bias)
All outcomes
High riskNo information was provided.

Incomplete outcome data (attrition bias)
All outcomes
High riskNo information was provided.

Selective reporting (reporting bias)High riskNo information was provided.

Other biasHigh riskNo information was provided.

Yakovlev 2010

MethodsTo retrospectively analyse the pain relief outcome of spinal cord stimulation in patients with cancer-related chest wall pain.


ParticipantsFrom 2005-2008,14 patients diagnosed with lung cancer underwent thoracotomy or lung resection and postoperative radiation therapy, and complained of intractable chronic chest pain.


Interventions14 patients received percutaneous implantation of permanent leads and stimulators at T3,T4,T5 after a successful trial of at least 2 days; stimulators were programmed with a pulse width of 400 to 450 microseconds and a rate of 50-60 Hz,amplitude ranged from 1.5-2.3 volts.


OutcomesRate of opioid use before and after treatment; pre procedure, 1 month post implant and 12 months post implant visual analogue scale; complication.


NotesNone


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskNo information of randomisation was provided.

Allocation concealment (selection bias)High riskNo information of allocation concealment was provided.

Blinding of participants and personnel (performance bias)
All outcomes
High riskNo information of blinding was provided.

Blinding of outcome assessment (detection bias)
All outcomes
High riskNo information of blinding of outcome assessment was provided.

Incomplete outcome data (attrition bias)
All outcomes
High riskNo information of patient dropout was provided.

Selective reporting (reporting bias)High riskNo information was provided.

Yakovlev 2011

MethodsTo retrospectively analyse the pain relief of spinal cord stimulation for intractable cancer-related lower back pain.


ParticipantsBetween 2005-2009,15 patients underwent surgical resections and radiation therapy because of metastatic disease related to colon, anal cancer, angiosarcoma of the sacrum, complained of intractable chronic low back pain.


Interventions15 patients received percutaneous implantation of permanent leads and stimulators at T11-12,T12/L1 after successful trial at least 2 days,stimulators were programmed with a pulse width of 390 to 480 microseconds and a rate of 40-60 Hz,amplitude ranged from 1.4-5.2 volts.


OutcomesRate of opioid use before and after treatment; pre procedure ,1 month post implant and 12 months post implant visual analogue scale; complications.


NotesNone


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskNo information was provided.

Allocation concealment (selection bias)High riskNo information was provided.

Blinding of participants and personnel (performance bias)
All outcomes
High riskNo information was provided.

Blinding of outcome assessment (detection bias)
All outcomes
High riskNo information was provided.

Incomplete outcome data (attrition bias)
All outcomes
High riskNo information was provided.

Selective reporting (reporting bias)High riskNo information was provided.

Other biasHigh riskNo information was provided.

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Cata 2004Individual case report

Clavo 2004Outcomes not related to the topic of systemic review

Clavo 2009Outcomes not related to the topic of systemic review

Eisenberg 2002Individual case report

Hamid 2007Individual case report.

Lee 2006Review article of SCS.

Lee 2009Individual case report.

Nouri 2011Individual case report.

Rainov 2007Outcomes not related to the topic of review.

Robaina 2007Individual case report.

Ting 2007Individual case report.

Tsubota 2009Individual case report.

Yakovlev 2008Case report including only 2 patients.

Yakovlev 2009Individual case report.

 
Comparison 1. Pain Intensity after SCS implantation

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Pain intensity---Visual Analogue Scale258Mean Difference (IV, Random, 95% CI)4.38 [3.93, 4.83]

 
Comparison 2. Pain intensity---1 month after SCS versus 12 months after SCS

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Pain Intensity---Visual Analogue Scale258Mean Difference (IV, Fixed, 95% CI)0.91 [0.50, 1.32]

 
Table 1. STROBE checklist

StructureItemRecommendation

Title and abstract1Indicate the study’s design with a commonly used term in the title or the abstract; provide in the abstract an informative and balanced summary of what was done
and what was found.

Introduction

Background/rationale2Explain the scientific background and rationale for the investigation being reported.

Objectives3State specific objectives, including any prespecified hypotheses.

Methods

Study design4Present key elements of study design early in the paper.

Setting5Describe the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection.

Participants6Give the eligibility criteria, and the sources and methods of selection of participants.

Variables7Clearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers. Give diagnostic criteria, if applicable.

Data sources/
measurement
8For each variable of interest, give sources of data and details of methods of assessment (measurement). Describe comparability of assessment methods if there
is more than one group.

Bias9Describe any efforts to address potential sources of bias.

Study size10Explain how the study size was arrived at.

Quantitative variables11Explain how quantitative variables were handled in the analyses. If applicable, describe which groupings were chosen and why.

Statistical methods12(a) Describe all statistical methods, including those used to control for confounding.
(b) Describe any methods used to examine subgroups and interactions.
(c) Explain how missing data were addressed.

(d) If applicable, describe analytical methods taking account of sampling strategy.

Results

Participants13(a) Report numbers of individuals at each stage of study—e.g. numbers potentially eligible, examined for eligibility, confirmed eligible, included in the study, completing follow-up, and
analysed.
(b) Give reasons for non-participation at each stage.
Participants
(c) Consider use of a flow diagram.

Descriptive
data
14(a) Give characteristics of study participants (e.g. demographic, clinical, social) and information on exposures and potential confounders.
(b) Indicate number of participants with missing data for each variable of interest.

Outcome data15Report numbers of outcome events or summary measures.

Main results16If relevant, consider translating estimates of relative risk into absolute risk for a meaningful time period.

Other analyses17Report other analyses done—e.g. analyses of subgroups and interactions, and sensitivity analyses.

Discussion

Key results18Summarise key results with reference to study objectives.

Limitations19Discuss limitations of the study, taking into account sources of potential bias or imprecision.
Discuss both direction and magnitude of any potential bias.

Interpretation20Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of analyses, results from similar studies, and other relevant evidence.

Generalisability21Discuss the generalisability (external validity) of the study results.

Other information

Funding22Give the source of funding and the role of the funders for the present study and, if applicable, for the original study on which the present article is based

 
Table 2. Result of STOBE Checklist

Item No.Meglio 1989Shimoji 1993Yakovlev 2010Yakovlev 2011

1YYYY

2NYYY

3NYYY

4NNNN

5NNYY

6NNNN

7NNNN

8NNNY

9NNNN

10NNNN

11YYYY

12NNNN

13NNNN

14NNNN

15YYYY

16NNNN

17NNNN

18YYYY

19NNNN

20YYYY

21YYYY

22NNYY

 Y:Yes; N:No; U:Unlear