For CLBP in working-aged adults (WAA): PT, exercise, CBT yes.
Most would argue SCS is reserved for tx of leg pain. When it is, it appears to lose effectiveness @ 2yrs. What references are you using for RFA?
N Engl J Med. 2000 Aug 31;343(9):618-24.
Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy.
Kemler MA1,
Barendse GA,
van Kleef M,
de Vet HC,
Rijks CP,
Furnée CA,
van den Wildenberg FA.
Author information
Abstract
BACKGROUND:
Chronic reflex sympathetic dystrophy (also called the complex regional pain syndrome) is a painful, disabling disorder for which there is no proven treatment. In observational studies, spinal cord stimulation has reduced the pain associated with the disorder.
METHODS:
We performed a randomized trial involving patients who had had reflex sympathetic dystrophy for at least six months. Thirty-six patients were assigned to receive treatment with spinal cord stimulation plus physical therapy, and 18 were assigned to receive physical therapy alone. The spinal cord stimulator was implanted only if a test stimulation was successful. We assessed the intensity of pain (on a visual-analogue scale from 0 cm [no pain] to 10 cm [very severe pain]), the global perceived effect (on a scale from 1 [worst ever] to 7 [best ever]), functional status, and the health-related quality of life.
RESULTS:
The test stimulation of the spinal cord was successful in 24 patients; the other 12 patients did not receive implanted stimulators. In an intention-to-treat analysis, the group assigned to receive spinal cord stimulation plus physical therapy had a mean reduction of 2.4 cm in the intensity of pain at six months, as compared with an increase of 0.2 cm in the group assigned to receive physical therapy alone (P<0.001 for the comparison between the two groups). In addition, the proportion of patients with a score of 6 ("much improved") for the global perceived effect was much higher in the spinal cord stimulation group than in the control group (39 percent vs. 6 percent, P=0.01). There was no clinically important improvement in functional status. The health-related quality of life improved only in the 24 patients who actually underwent implantation of a spinal cord stimulator. Six of the 24 patients had complications that required additional procedures, including removal of the device in 1 patient.
CONCLUSIONS:
In carefully selected patients with chronic reflex sympathetic dystrophy, electrical stimulation of the spinal cord can reduce pain and improve the health-related quality of life.
N Engl J Med. 2006 Jun 1;354(22):2394-6.
Spinal cord stimulation for chronic reflex sympathetic dystrophy--five-year follow-up.
Kemler MA,
de Vet HC,
Barendse GA,
van den Wildenberg FA,
van Kleef M.
J Neurosurg. 2008 Feb;108(2):292-8. doi: 10.3171/JNS/2008/108/2/0292.
Effect of spinal cord stimulation for chronic complex regional pain syndrome Type I: five-year final follow-up of patients in a randomized controlled trial.
Kemler MA1,
de Vet HC,
Barendse GA,
van den Wildenberg FA,
van Kleef M.
Author information
Abstract
OBJECT:
Chronic complex regional pain syndrome-Type I (CRPS-I) is a painful, disabling disorder for which no treatment with proven effect is available. In the present randomized controlled trial, the authors assessed the effectiveness of spinal cord stimulation (SCS) in reducing pain due to CRPS-I at the 5-year follow-up.
METHODS:
The authors performed a randomized trial in a 2:1 ratio in which 36 patients with CRPS-I were allocated to receive SCS and physical therapy (PT) and 18 patients to receive PT alone. Twenty-four patients who received SCS+PT also underwent placement of a permanent spinal cord stimulator after successful test stimulation; the remaining 12 patients did not receive a permanent stimulator. The authors assessed pain intensity, global perceived effect, treatment satisfaction, and health-related quality of life. Patients were examined before randomization, before implantation, and every year until 5 years thereafter. Ten patients were excluded from the final analysis.
RESULTS:
At 5 years posttreatment, SCS+PT produced results similar to those following PT for pain relief and all other measured variables. In a subgroup analysis, the results with regard to global perceived effect (p=0.02) and pain relief (p=0.06) in 20 patients with an implant exceeded those in 13 patients who received PT.
CONCLUSIONS:
Despite the diminishing effectiveness of SCS over time, 95% of patients with an implant would repeat the treatment for the same result.