![]() ![]() These tactics included publishing lengthy critiques in paywalled industry-affiliated journals rather than the journal where the original study was published. In a recent commentary in JAMA Internal Medicine, two of the Cochrane review authors discussed tactics used by the spinal cord stimulator industry to dismiss the findings of their review and other independent reviews and studies that came to similar conclusions. The data do not support the use of spinal cord stimulation to manage low back pain outside of a clinical trial, and it is unclear if spinal cord stimulation has long-term clinical benefits to reasonably outweigh the costs and risks of surgical intervention. Three smaller trials suggested that “adding spinal cord stimulation to medical management may slightly improve function and slightly reduce opioid use in the medium term (i.e., one to less than 12 months).” Based on these findings, Dr. The largest study, with 50 participants, found no statistical benefits. Overall, the body of evidence was assessed as having significant bias, including selection bias (five studies), performance and detection bias (10 studies), attrition bias, and selective reporting bias. ![]() Most studies reported outcomes at follow-up dates of one month or less only one study reported outcomes at six months. Primary outcomes included pain intensity, physical function, and quality of life. Brian Nelson and colleagues summarized a Cochrane review of 13 placebo-controlled trials with 699 adult participants (mean age 47 to 59 years) who had low back pain for at least 12 weeks. These devices come with a high price tag ($30,000) and potential complications that include electrode migration, hematoma formation, infection, spinal cord injury, and cerebrospinal fluid leak. A Cochrane for Clinicians article in the December 2023 issue of American Family Physician reviewed randomized trials assessing the effectiveness of surgically implanted spinal cord stimulation devices for the treatment of chronic low back pain. ![]()
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