The data on spinal cord stimulators is in, and the news is NOT good.
Recent research, done in Australia and led by Dr Adrian Traeger, published in the Cochrane Database of Systematic Reviews found:
“Data in this review do not support the use of spinal cord stimulation to manage low back pain outside a clinical trial. Current evidence suggests spinal cord stimulation does not have sustained clinical benefits that would outweigh the costs and risks of this surgical intervention,” researchers led by Dr Adrian Traeger (PhD), senior research fellow at the Institute for Musculoskeletal Health at the University of Sydney, concluded.
Dr Traeger is a highly regarded scientist, who has done great work in the pain field. I trust what he has to say.
The review included 699 participants with chronic pain, ranging in duration from five to 12 years, across 13 randomised trials, found moderate-certainty evidence that spinal cord stimulators do not improve back or leg pain, quality of life or function after six months.
They found that people who had a spinal cord stimulator rated their pain at 65 out of 100, and people who received placebo rated their pain at 61 out of 100. A similar lack of efficacy was found for quality of life and function measures.
Given the risks of a surgical procedure and an implanted device, and the fact that most people don’t benefit, its hard to understand how spinal cord stimulators became such an accepted treatment option.
People are often force tapered off their long term opioid therapy, where they were stable and receiving good benefit, and given a spinal cord stimulator in stead.
My pain management doctor tried to do this to me. It was almost a black mail situation – try the stimulator or I will no longer prescribe.
My pain management doctor tried to do this to me. It was almost a blackmail situation – try the stimulator or I will no longer prescribe your pain medications. He also required a cash payment of $3500 for ‘life time maintenance of the device’. Given most spinal cord stims are removed, and he still keeps the money, that’s a pretty good deal.
My response was to find a new pain management doctor. But I live in Canberra, where there are several practices and quite a few options. What about people who don’t have that option? It’s easy to say ‘find a new doctor’ but much harder to actually DO.
And while I have options, I have no idea if my new doctor will present me with the same ‘choice’. Or even take me on as a patient, or agree to continue my long term opioid therapy.
This is the state of care of chronic secondary pain, or severe, daily pain, or intractable pain, in Australia, in 2023.