RESUMO
BACKGROUND: Chronic pain in head, neck, shoulders and upper limbs is debilitating, and patients usually rely on pain medications or surgery to manage their symptoms. However, given the current opioid epidemic, non-pharmacological interventions that reduce pain, such as spinal cord stimulation (SCS), are needed. The purpose of this study was to review the evidence on paresthesia-free 10 kHz SCS therapy for neck and upper extremity pain. METHODS: Systematic literature search was performed for studies reporting outcomes for cervical 10 kHz SCS using date limits from May 2008 to November 2020. The study results were analyzed and described qualitatively. Additionally, when feasible, meta-analyses of the outcome data, with 95% confidence intervals (CIs), were conducted using both the fixed-effects (FE) and random-effects (RE) models. RESULTS: A total of 15 studies were eligible for inclusion. The proportion of patients who achieved ≥ 50% pain reduction was 83% (95% CI 77-89%) in both the FE and RE models. The proportion of patients who reduced/eliminated their opioid consumption was 39% (95% CI 31-46%) in the FE model and 39% (95% CI 31-48%) in the RE model. Pain or discomfort with the implant, lead migration, and infections were potential risks following cervical SCS. Explant rate was 0.1 (95% CI 0.0-0.2) events per 100 person-months, and no patients in the included studies experienced a neurological complication or paresthesia. CONCLUSION: Findings suggest 10 kHz SCS is a promising, safe, minimally invasive alternative for managing chronic upper limb and neck pain.
RESUMO
Traditional (40-50 Hz) spinal column stimulation is an efficacious and widely accepted treatment for chronic neuropathic pain conditions. However, there are major challenges including its ineffectiveness for axial back pain, the burden of paresthesia-related discomfort and difficulties producing indisputable research. Recently, there have been the major technological innovations of high-frequency and burst stimulation. Studies have shown these to provide improved analgesia even for axial pain without the problems associated with paresthesia. Dorsal root ganglion stimulation may be useful in certain subsets of patients with dermatomal distribution of pain. Other scientific data and technological improvements such as recent research on cost-effectiveness, MRI compatibility and very recent advances in spinal column stimulation are appraised.