Disclosures: Elver S. Ho: Bionano Genomics (Products/Services: No) (Stockholder/Ownership Interest (excluding diversified mutual funds))Senseonics (Products/Services: No) (Stockholder/Ownership Interest (excluding diversified mutual funds))

Objective: Complex Regional Pain Syndrome (CRPS) is a chronic debilitating neuropathic pain condition characterized by autonomic and inflammatory features that typically occurs after a traumatic event. Spinal cord stimulation (SCS) has been shown to be effective in the treatment of chronic CRPS refractory to conventional treatment modalities. The collective evidence of unconventional waveforms of SCS for treating CRPS has not been characterized extensively.

Design: For this systematic Review with meta-analysis, PubMed, Embase and CINHLA were queried for peer-reviewed randomized controlled trials (RCT) using SCS to treat CRPS. Risk of bias (ROB) assessment was performed using the Cochrane ROB 2 tool. Meta-analyses were performed for eligible RCTs with Revman 5.4 software.

Setting: N/A

Participants: N/A

Interventions: Analysis of published research.

Main Outcome Measures: Pain scores and global perceived effect.

Results: Four RCTs were identified that included SCS as a treatment arm for CRPS. Of these, 1 study compared low frequency tonic SCS (LF-SCS) versus conventional physical therapy, 2 studies compared placebo/sham SCS with LF-SCS and a multitude of waveforms, and 1 study compared LF-SCS with High-Frequency SCS (HF-SCS). Two of the studies were rated as having a low risk of bias, one study was rated as having some concerns for bias while the final study was rated as having a high risk of bias. A pooled analysis of 4 studies comparing conventional therapy/placebo SCS stimulation against LF-SCS revealed increased benefit of LF-SCS in pain reduction up to a month (MD=-1.17 points; 95%CI=-1.61, -0.73; p < 0.001, I2=42%). Another pooled analysis of 2 studies showed that LF-SCS results in higher global perceived effect scores relative to conventional therapy/placebo SCS stimulation (MD=1.58; 95%CI=1.00, 2.15; p < 0.001, I2=0%).

Conclusions: LF-SCS moderately improves pain outcomes compared to conventional therapy/placebo SCS stimulation. More evidence is required to demonstrate that novel SCS parameters are superior to LF-SCS in improving pain scores and functional outcomes.

Level of Evidence: Level I

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/waveforms-of-spinal-cord-stimulation-in-complex-regional-pain-syndrome-systematic-review-and-meta-analysis-of-randomized-controlled-trials/