Spinal cord stimulation for complex regional pain syndrome: A systematic review of the clinical and cost‐effectiveness literature and assessment of prognostic factors

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Abstract
Objective To review the clinical and cost‐effectiveness of spinal cord stimulation (SCS) in the management of patients with complex regional pain syndrome (CRPS) and identify the potential predictors of SCS outcome.Design Systematic review of the literature and meta‐regression.Methods Electronic databases were searched for controlled and uncontrolled studies and economic evaluations relating to the use of SCS in patients with either CRPS type I or II.Results One randomised controlled trial, 25 case series and one cost‐effectiveness study were included. In the randomised controlled trial in type I CRPS patients, SCS therapy lead to a reduction in pain intensity at 24 months of follow‐up (mean change in VAS score −2.0), whereas pain was unchanged in the control group (mean change in VAS score 0.0) (p < 0.001). In the case series studies, 67% (95% CI 51%, 84%) of type I and type II CRPS patients implanted with SCS reported pain relief of at least 50% over a median follow‐up period of 33 months. No statistically significant predictors of pain relief with SCS were observed in multivariate meta‐regression analysis across studies. An economic analysis based on the randomised controlled trial showed a lifetime cost saving of approximately €58,470 (US$60,800) with SCS plus physical therapy compared with physical therapy alone. The mean cost per quality‐adjusted life‐year at 12‐month follow‐up was €22,580 (US$23,480).Conclusions SCS appears to be an effective therapy in the management of patients with CRPS type I (Level A evidence) and type II (Level D evidence). Moreover, there is evidence to demonstrate that SCS is a cost‐effective treatment for CRPS type I.

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