Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain
Return to Work
Return to work is an expected beneficial outcome in patients whose uncontrolled chronic pain was the only impediment to gainful employment. Employment status, however, depends upon many factors beyond pain control, including the patient's training and education, field of employment, work history, overall physical condition, and age.
Furthermore, it is not unusual for SCS patients to have been disabled by their pain and unable to work for a significant period of time while they were unsuccessfully treated with other therapies prior to receiving SCS. Any significant unemployment period decreases the likelihood of return to work even after successfully treatment.
Some SCS patients, as reported in the literature cited below, however, do return to work, and it is reasonable to assume that when SCS treatment is offered earlier in the treatment continuum more disabled patients will to be able to return to work.
Assessment of work status relies upon patient self-report.
| Strength of Recommendation | Evidence source(s)/rationale |
| N/A -- information only | N/A -- see Bibliography for relevant literature |
Waddell G, Burton AK. Occupational health guidelines in the management of low back pain at work: Evidence reviews. Occup Med 51(2):124-135, 2001.
Abstract van Buyten J-P, van Zundert JV, Milbouw G. Treatment of failed back surgery syndrome patients with low back and leg pain: a pilot study of a new dual lead spinal cord stimulation system. Neuromodulation 2(4):258-265, 1999.
Abstract | Wikistim Entry Sundaraj SR, Johnstone C, Noore F, Wynn P, Castro M. Spinal cord stimulation: a seven-year audit. J Clin Neurosci 12(3):264-270, 2005.
Abstract | Wikistim Entry Spiegelmann R, Friedman WA. Spinal cord stimulation: a contemporary series. Neurosurgery 28(1):65-70, 1991.
Abstract | Wikistim Entry North RB, Ewend ME, Lawton MA, Piantadosi S. Spinal cord stimulation for chronic, intractable pain: superiority of "multi-channel" devices. Pain 44(2):119-130, 1991.
Abstract | Wikistim Entry North RB, Kidd DH, Farrokhi F, Piantadosi S. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain:a randomized, controlled trial. Neurosurgery 56(1):98-106, 2005.
Abstract | Wikistim Entry North RB, Kidd DH, Olin J, Sieracki JM, Farrokhi F, Petrucci L, Cutchis PN. Spinal cord stimulation for axial low back pain: a prospective, controlled trial comparing dual with single percutaneous electrodes. Spine 30(12):1412-1418, 2005.
Abstract | Wikistim Entry Milhous RL, Haugh LD, Frymoyer JW, Ruess JM, Gallagher RM, Wilder DG, Callas PW. Determinants of vocational disability in patients with low back pain. Arch Phys Med Rehabil 70:589-593, 1989.
Abstract Leclercq TA, Russo E. Epidural stimulation for pain control [French]. Neurochirurgie 27(2):125-128, 1981.
Abstract | Wikistim Entry Kupers RC, Van den Oever R, Van Houdenhove B, Vanmechelen W, Hepp B, Nuttin B, Gybels JM. Spinal cord stimulation in Belgium: a nation-wide survey on the incidence, indications and therapeutic efficacy by the health insurer. Pain 56(2):211-216, 1994.
Abstract | Wikistim Entry Kumar K, Toth C. The role of spinal cord stimulation in the treatment of chronic pain postlaminectomy. Curr Pain Headache Rep 2:85-92, 1998.
Kumar K, Toth C, Nath RK, Laing P. Epidural spinal cord stimulation for treatment of chronic pain--some predictors of success. A 15-year experience. Surg Neurol 50(2):110-120, 1998.
Abstract | Wikistim Entry Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, Thomson S, O’Callaghan J, Eisenberg E, Milbouw G, Buchser E, Fortini G, Richardson, J, North RB The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery 63(4):762-768, 2008.
Abstract | Wikistim Entry Kumar K, Hunter G, Demeria D. Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and present status, a 22-year experience. Neurosurgery 58(3):481-494, 2006.
Abstract | Wikistim Entry Kumar A, Felderhof C, Eljamel MS. Spinal cord stimulation for the treatment of refractory unilateral limb pain syndromes. Stereotact Funct Neurosurg 81(1-4):70-74, 2003.
Abstract | Wikistim Entry Kumar K, Malik S, Demeria D. Treatment of chronic pain with spinal cord stimulation versus alternative therapies: cost-effectiveness analysis. Neurosurgery 51(1):106-116, 2002.
Abstract | Wikistim Entry Harke H, Gretenkort P, Ladleif HU, Koester P, Rahman S. Spinal cord stimulation in postherpetic neuralgia and in acute herpes zoster pain. Anesth Analg 94(3):694-700, 2002.
Abstract | Wikistim Entry Fritz JM, George SZ, Delitto A. The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. Pain 94:7-15, 2001.
Abstract Fiume D, Sherkat S, Callovini GM, Parziale G, Gazzeri G. Treatment of the failed back surgery syndrome due to lumbo-sacral epidural fibrosis. Acta Neurochir Suppl 64:116-118, 1995.
Abstract | Wikistim Entry Devulder J, de Laat M, van Bastelaere M, Rolly G. Spinal cord stimulation: a valuable treatment for chronic failed back surgery patients. J Pain Symptom Manage 13(5):296-301, 1997.
Abstract | Wikistim Entry De Mulder PA, te Rijdt B, Veeckmans G, Belmans L. Evaluation of a dual quadripolar surgically implanted spinal cord stimulation lead for failed back surgery patients with chronic low back and leg pain. Neuromodulation 8(4):219-224, 2005.
Abstract | Wikistim Entry de la Porte C, Siegfried J. Lumbosacral spinal fibrosis (spinal arachnoiditis). Its diagnosis and treatment by spinal cord stimulation. Spine 8(6):593-603, 1983.
Abstract | Wikistim Entry Dario A, Fortini G, Bertollo D, Bacuzzi A, Grizzetti C, Currari S. Treatment of failed back surgery syndrome. Neuromodulation 4(3):105-110, 2001.
Abstract Calvillo O, Racz G, Didie J, Smith K. Neuroaugmentation in the treatment of complex regional pain syndrome of the upper extremity. Acta Orthop Belg 64(1):57-63, 1998.
Abstract | Wikistim Entry Burton AW, Fukshansky M, Brown J, Hassenbusch SJ III. Refractory insomnia in a patient with spinal cord stimulator lead migration. Neuromodulation 7(4):242-245, 2004.
Abstract | Wikistim Entry Burchiel KJ, Anderson VC, Brown FD, Fessler RG, Friedman WA, Pelofsky S, Weiner RL, Oakley J, Shatin D. Prospective, multicenter study of spinal cord stimulation for relief of chronic back and extremity pain. Spine 21(23):2786-2794, 1996.
Abstract | Wikistim Entry Budd K. Spinal cord stimulation: cost-benefit study. Neuromodulation 5(2):75-78, 2002.
Abstract | Wikistim Entry Broseta J, Roldán P, González-Darder J, Bordes V, Barcia-Salorio JL. Chronic epidural dorsal column stimulation in the treatment of causalgic pain. Appl Neurophysiol 45:190-194, 1982.
Abstract | Wikistim Entry Bel S, Bauer BL. Dorsal column stimulation (DCS): cost to benefit analysis. Acta Neurochir 52(Suppl):121-23, 1991.
Abstract | Wikistim Entry
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