Details of HTA project
Last updated: 26 August 2008 - Next update due: 2 September 2008
Research type: |
NICE Technology Assessment Report (TAR) |
Project title: |
Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin |
Link to NICE guidance page |
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Project ref: |
07/08/01 |
Cost: |
This project has been commissioned by the HTA programme on behalf of the National Institute for Health and Clinical Excellence on a call-off contract basis. |
Chief Investigator : |
School of Health and Related Research (ScHARR-TAG), University of Sheffield |
Start Date: |
August 2007. |
Publication date: |
April 2009. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed. |
Plain English Summary |
Chronic pain is an important cause of physical and emotional suffering, familial and social disruptions, disability and work absenteeism. It is defined by its duration, typically greater than three months beyond normal tissue healing time, and is usually less directly related to identifiable tissue damage. In addition to its duration and lack of associated pathology, chronic pain is frequently identified by an unpredictable prognosis and many associated psychological problems - particularly depression and anxiety - and may include varying amounts of disability, from none to severe. Chronic pain syndromes include: chronic low back pain, fibromyalgia, neuropathic pain, phantom limb pain and central pain syndromes. Chronic pain can be continuous or intermittant3. Published estimates of the prevalence of chronic pain vary widely. Elliott et al reporting a range from 2% to 45% suggest that some of this variation can be ascribed to poor instruments, inadequate size and to studies concentrating on specific diagnoses within chronic pain. Their own study in the Grampian region of the UK reported a prevalence of 50.4% among adults. Overall prevalence increased with age (from around 30% of those aged 25-34 to around 60% in those older than 65 years). The two commonest causes of pain were back pain (16%) and arthritis (16%) - back pain varied little with age, while arthritis and angina (4.5% of sample) both increased consistently with age. Severe chronic pain was reported by 10.8% of respondents. Neuropathic pain is produced by damage to, or pathological changes in the peripheral or central nervous systems. The mechanisms involved in neuropathic pain are complex and involve both peripheral and central pathophysiologic phenomenon. Ischaemic pain occurs when there is insufficient blood flow for the metabolic needs of an organ. It can be very severe and is commonly felt in the legs but it could occur anywhere. The pain of a heart attack is the prototypical example of ischaemic pain. Spinal cord stimulation (SCS) has been used since 1967 to treat patients with intractable pain syndromes including the failed back surgery syndrome (chronic low back pain which has failed to respond to surgical treatment), and ischaemic cardiac and limb pain. The exact mechanism is unknown, but the technique may inhibit chronic pain by stimulating large diameter afferent nerve fibres in the spinal cord. The implantation procedure involves placing leads in the epidural space, along with an implantable generator and controller that allows alteration of parameters such as pulse width, duration and intensity of stimulation. Repetitive electrical impulses are then delivered to the spinal cord. SCS is not curative for the underlying condition, and may not be a stand-alone treatment but will be provided within the context of the multi-disciplinary care team. Expected benefits of SCS are reduction in pain, improved function (including general activities of daily living and also return to work), generally improved quality of life, and may reduce pain medication usage. Reduction in pain may improve sleep and also increase alertness by allowing reductions in drug intake. The aim of this review is to systematically evaluate and appraise the potential clinical and cost effectiveness of SCS for the treatment of chronic neuropathic and ischaemic pain. The outcome measures to be considered are likely to include levels of pain relief, physical activity, health-related quality of life, survival and adverse effects of treatment. The costs and cost-effectiveness will be assessed from the perspective of the NHS and Personal Social Services. Several types of SCS devices are available in the UK. Where evidence is available an assessment will be undertaken on individual devices. Where evidence is not available then assumptions will be made on the effectiveness of the devices. |
Abstract: |
The assessment will address the question 'What is the clinical and cost effectiveness of spinal cord stimulation in the management of chronic pain of neuropathic or ischaemic origin?' The objectives of the review are: -To evaluate the clinical effectiveness of SCS in terms of pain, health-related quality of life, physical and functional abilities, anxiety and depression. -To evaluate the side-effect profile of SCS. -To estimate the incremental cost-effectiveness of SCS compared with current standard therapy. -To estimate the potential overall cost to the NHS in England and Wales. The NIHR HTA programme commissioned this report on behalf of the National Institute for Health and Clinical Excellence. |
NRR* number, if applicable: |
N0484196302 (*National Research Register) |
Project Protocol: |
Project protocol not available |
URL of this page: |
http://www.hta.ac.uk/1677 |
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