Spinal analgesia: The effectiveness of spinal cord stimulator in treating complex regional pain syndrome in injured workers

Abstract

The WCBBC spends over $200 million annually on healthcare related payments for injured worker assessments, diagnostics and treatment/rehabilitation services. One such treatment modality the WCBBC is asked to pay for is spinal cord stimulation (SCS) for treating Complex Regional Pain Syndrome (CRPS). The aim was to describe the outcome of a systematic review on the effectiveness of SCS in treating CRPS -to describe the outcome of WCBBC claims associated with SCS and CRPS. Systematic review: In early 2001, the WCBBC commissioned external consultant to conduct a standard systematic review on SCS and CRPS. During the period of Jan 2000 - March 2002, Medical Advisors, who were asked to approve SCS on advice from pain specialists treating injured workers, were asked to submit the claim number of these claimants to the Senior Medical Advisor. Reviews on the medical records and invoices related to these claimants were undertaken by the EBPG. Systematic review: 35 studies were relevant to the review criteria. Only 1 of these studies represented an RCT of higher quality. The systematic review concluded that there was insufficient evidence for the effectiveness of SCS in treating patients with CRPS. Outcome of SCS treatment in WCB claimants: There were 47 claimants who were deemed appropriate for SCS implantation approval. 30 (63.8%) were diagnosed with CRPS while the rest were diagnosed with chronic pain of various origins. 28 (59.6%) were approved for SCS implantation; of these 28, 18 (64.3%) were diagnosed with CRPS. 23 (82.2%) of the approved claimants had the SCS implanted. Of these, 12 (52.2%) had a successful trial implant. Of these 12 with permanent implant, 10 (83.3%) were diagnosed with CRPS. At 23 months follow-up 6 CRPS claimants, 3 with SCS and 3 without SCS returned to work.