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Clinical Effectiveness and Mechanism of Action of Spinal Cord Stimulation for Treating Chronic Low Back and Lower Extremity Pain: a Systematic Review

  • Other Pain (N Vadivelu and AD Kaye, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of the present systematic review is to provide a current understanding of the mechanism of action and the evidence available to support clinical decision-making. The focus is to summarize randomized controlled trials (RCTs) and nonrandomized or observational studies of spinal cord stimulation in chronic pain to understand clinical effectiveness and the mechanism of action.

Recent Findings

Several recent studies have demonstrated the benefit of spinal cord stimulation in managing chronic pain. Until recently, the mechanism of action was founded on a central paradigm derived from gate control theory, which is the need to stimulate the dorsal column of the spinal cord to generate paresthesia. The recent development of new therapies that do not rely on paresthesia has left the field without a clear mechanism of action that could serve as a strong foundation to further improve clinical outcomes. Consequently, multiple theories have emerged to explain how electrical pulse applied to the spinal cord could alleviate pain, including activation of specific supraspinal pathways, and segmental modulation of the neurological interaction. Recent systematic reviews also have shown the clinical effectiveness of spinal cord stimulation in managing chronic spinal pain, phantom limb pain, complex regional pain syndrome, and other chronic painful conditions.

Summary

Spinal cord stimulation for the treatment of chronic pain is rapidly evolving with technology at its forefront. This comprehensive focused review evaluated 11 RCTs and 7 nonrandomized/observational studies which provided levels of evidence ranging from I to II.

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Author information

Authors and Affiliations

  1. Millennium Pain Center – National Spine and Pain Centers, 2406 E Empire, Bloomington, IL, 61704, USA

    Ricardo Vallejo & Ramsin Benyamin

  2. Department of Psychology, Illinois Wesleyan University, Bloomington, IL, USA

    Ricardo Vallejo, David L. Cedeno & Ramsin Benyamin

  3. SGX Medical LLC, Bloomington, IL, USA

    Ricardo Vallejo & David L. Cedeno

  4. South Texas Orthopaedic Research Institute, Laredo, TX, USA

    Ashim Gupta

  5. BioIntegrate, 2505 Newpoint Pkwy Suite 100-A, Lawrenceville, GA, USA

    Ashim Gupta

  6. Future Biologics, Lawrenceville, GA, USA

    Ashim Gupta

  7. Lumbrera LLC, 2406 E Empire, Bloomington, IL, 61704, USA

    David L. Cedeno, Alejandro Vallejo & William J. Smith

  8. Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA

    Alejandro Vallejo

  9. Geisel School of Medicine, Dartmouth College, Hanover, NH, USA

    William J. Smith

  10. College of Osteopathic Medicine, Des Moines University, Des Moines, IA, USA

    Samuel M. Thomas

  11. College of Medicine, University of Illinois, Urbana-Champaign, IL, USA

    Ramsin Benyamin

  12. Department of Anesthesiology, LSU Health Science Center, 1542 Tulane Ave Room 659, New Orleans, LA, 70112, USA

    Alan D. Kaye

  13. Department of Pharmacology, LSU Health Science Center, 1542 Tulane Ave Room 659, New Orleans, LA, 70112, USA

    Alan D. Kaye

  14. Pain Management Centers of America, Management Center of Paducah, 67 Lakeview Dr., Paducah, KY, 42001, USA

    Laxmaiah Manchikanti

  15. Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA

    Laxmaiah Manchikanti

  16. Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA

    Laxmaiah Manchikanti

Authors
  1. Ricardo Vallejo
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  2. Ashim Gupta
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  3. David L. Cedeno
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  4. Alejandro Vallejo
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  5. William J. Smith
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  6. Samuel M. Thomas
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  7. Ramsin Benyamin
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  8. Alan D. Kaye
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  9. Laxmaiah Manchikanti
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Corresponding author

Correspondence to David L. Cedeno.

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Conflict of Interest

Dr. Ricardo Vallejo is a paid consultant and advisory board member for Medtronic Inc.

Dr. Ashim Gupta declares no conflict of interest.

Dr. David L. Cedeño is a paid consultant and advisory board member for Medtronic Inc.

Mr. Alejandro Vallejo declares no conflict of interest.

Mr. William J. Smith declares no conflict of interest.

Mr. Samuel M. Thomas declares no conflict of interest.

Dr. Ramsin Benyamin is a paid consultant for Medtronic Inc.

Dr. Alan D. Kaye is a speaker for Merck and a Section Editor for Current Headache and Pain Reports. He has not been involved in the editorial handling of this manuscript.

Dr. Laxmaiah Manchikanti declares no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Other Pain

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Vallejo, R., Gupta, A., Cedeno, D.L. et al. Clinical Effectiveness and Mechanism of Action of Spinal Cord Stimulation for Treating Chronic Low Back and Lower Extremity Pain: a Systematic Review. Curr Pain Headache Rep 24, 70 (2020). https://doi.org/10.1007/s11916-020-00907-2

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