Authors' results and conclusions: Both high-frequency spinal cord stimulation (HF SCS) and dorsal root ganglion stimulation (DRGS) are examples of neuromodulatory technologies which are yet to be widely studied in comparative trials with large numbers of patients. Future studies of HF SCS (across different frequency parameters) and DRGS with traditional SCS and sham treatment as the comparators are needed in patients naive to any form of SCS to better establish the effectiveness of modified forms of SCS relative to traditional SCS and properly investigate any placebo effect. Both clinicians and industry have emphasised the importance of careful patient selection, including proper psychological assessment in the application of both traditional and newly emerging SCS techniques. Application of the technology needs to be carefully considered within the broad context of the pain care in Australia, which typically occurs in a fragmented fashion across different medical disciplines, with communication and collaboration lacking between different medical specialties, craft groups and other professional bodies. Open communication and inter-disciplinary cooperation across the broad area of pain management should be considered as key supports to achieve the best possible outcomes for patients from SCS technology in the future.

Authors' recommendations: The evidence presented in this brief has demonstrated mostly consistent benefits for patients with neuropathic pain treated with HF SCS or DRGS. However, it is unclear from the current evidence base the possible role the placebo effect may play in terms of pain reduction. Appropriately designed studies including a sham treatment arm would clarify any placebo effect. In addition, HF SCS devices are considerably more expensive than conventional spinal cord stimulation devices. Therefore, HealthPACT does not support investment in this technology in clinical practice at this time, however, HealthPACT recommends that the evidence be reviewed again in 24 months.

Project Status: Completed

Year Published: 2015

URL for published report: Not Available

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)