High-Frequency Spinal Cord Stimulation for Chronic Pain: Pre-Clinical Overview and Systematic Review of Controlled Trials

Mark Bicket, Roger Y. Dunn, Shihab U. Ahmed

Research output: Contribution to journalReview article

Abstract

OBJECTIVE: To assess the evidence base for high-frequency spinal cord stimulation (HFSCS). HFSCS has the potential to provide paresthesia-free pain relief for patients with chronic pain, in contrast to conventional spinal cord stimulation, which produces distracting and potentially unpleasant paresthesias.

DESIGN: A systematic review following standard methodological guidelines (Prospero #CRD42015029215).

METHODS: We searched PubMed to March 14, 2016 without language restriction and hand-checked reference lists. Two authors independently performed study selection, bias evaluations, and data extraction. The pre-clinical review selected studies focusing on the mechanism and non-human experience with HFSCS. Clinically, any prospective study of adults using HFSCS (≥ 1000 Hz) was included.

RESULTS: Pre-clinical studies have characterized many aspects underlying the mechanism of HFSCS. For the clinical systematic review, eight trials (236 participants randomized or 160 followed prospectively) met inclusion criteria. All trials of HFSCS focused on patients with chronic low back pain with one exception, which included patients with chronic migraine. All but one trial documented funding by industry. Performance bias due to unmasked participants, physicians, and outcome assessors limited the quality of all but one study.

CONCLUSIONS: Significant growth in the preclinical and clinical evidence base for HFSCS suggests that HFSCS may differ from conventional SCS in mechanism of action and efficacy of treatment, respectively. Addressing current knowledge gaps in clinical evidence will require standardization in trial reporting and leveraging the paresthesia-free characteristic of HFSCS to enable masking in high-quality randomized controlled trials.

Original languageEnglish (US)
Pages (from-to)2326-2336
Number of pages11
JournalPain medicine (Malden, Mass.)
Volume17
Issue number12
DOIs
StatePublished - Dec 1 2016

Fingerprint

Spinal Cord Stimulation
Chronic Pain
Paresthesia
Selection Bias
Low Back Pain
Migraine Disorders
PubMed
Industry
Language
Randomized Controlled Trials
Hand
Prospective Studies
Guidelines

Keywords

  • Chronic Pain
  • High Frequency
  • Spinal Cord Stimulation
  • Systematic Review

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

High-Frequency Spinal Cord Stimulation for Chronic Pain : Pre-Clinical Overview and Systematic Review of Controlled Trials. / Bicket, Mark; Dunn, Roger Y.; Ahmed, Shihab U.

In: Pain medicine (Malden, Mass.), Vol. 17, No. 12, 01.12.2016, p. 2326-2336.

Research output: Contribution to journalReview article

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