A Systematic Evaluation of Burst Spinal Cord Stimulation for Chronic Back and Limb Pain.

BACKGROUND Traditional tonic spinal cord stimulation (SCS) has been approved by FDA for chronic pain of intractable back and limb pain. However, it induces paresthesia and relieves pain poorly to some extent. Recently, burst SCS has been developed for pain reduction without the mandatory paresthesia. STUDY DESIGN A systematic review of burst SCS for chronic back and limb pain. OBJECTIVE The objective of this systematic review is to determine the effects of burst SCS on pain relief without paresthesia for various conditions including failed back surgery syndrome, painful diabetic neuropathy, and radiculopathy. METHODS The available literature on burst SCS in managing chronic pain without paresthesia was reviewed. The 2011 American Academy of Neurology (AAN) Classification of Evidence Guidelines Process Manual was used to grade the evidence and risk of bias. Data sources included relevant literature identified through searches of PubMed, MEDLINE/OVID, SCOPUS, and manual searches of the bibliographies of known primary and review articles. OUTCOME MEASURES The primary outcome measure was pain relief and paresthesia status. Secondary outcome measures were improvement in pain quality, functional status, and complications. RESULTS For this review, five studies including a total of 117 patients met the eligibility criteria. All studies were graded a Class IV study. LIMITATIONS The limitations of this systematic review include an overall paucity of high quality studies. CONCLUSION Burst SCS is a new approach that possibly causes more pain reduction for short-term duration than tonic SCS without eliciting paresthesia. The evidence based on this systematic review for burst SCS in treating chronic intractable pain is considered fair and limited. This is an AAN recommendation level U. Further research is needed with a larger sample size and a standardized study design.