Background & Aims
Electric neuromodulation (e.g Spinal Cord Stimulation, SCS; or Dorsal Root Ganglion Stimulation, DRG) is a treatment option for intractable chronic neuropathic pain. However, literature is scarce on the impact of SCS on physical activity level among patients with neuropathic pain. There is a paucity of studies in this context describing physiotherapeutic regimens and the additive effects of physiotherapist-led exercise to SCS treatment. This study, therefore, aims to describe a patient sample with chronic neuropathic pain accepted for treatment with SCS in terms of pain intensity, physical activity level, and health related quality of life (HRQL) and further to examine effects of a 3-month SCS treatment on those variables.
Methods
This randomized controlled trial (RCT) recruited neuropathic pain patients (age >18 years) accepted for spinal cord stimulation (SCS) treatment at the Sahlgrenska University Hospital, Gothenburg, Sweden. The RCT is the first phase of a three-step complex intervention study assessing the efficacy of physiotherapist-led exercise and physical activity on prescription (PAP) as add-on to SCS treatment. After implantation with a SCS, participants were randomized (1:1) to active SCS or conventional medical treatment for 3 months. Pain intensity was measured with the Numerical Rating Scale (NRS; 0-10). Physical activity data were collected through accelerometery over the course of one week before implantation (at baseline) and one week 3 months after implantation (3-month follow-up). HRQL was assessed with the Visual Analogue Scale (VAS) of the EuroQol 5-dimensions questionnaire (EQ5D-VAS; 0-100).
Results
A total of 48 participants were included in the trial, of whom 42 received the permanent SCS and were randomized to active SCS (n = 21) or conventional medical treatment (n=21). Twenty participants from the conventional medical treatment group crossed over to the active SCS group in connection to implantation by patient request due to substantial pain relief. The study can hence be considered a prospective single-arm trial. Mean neuropathic pain intensity was 6.7 (SD=1.7) at baseline and significantly reduced to 4.5 at follow-up (SD=1.6, p < 0.001, 95% CI -2.4 to -1.6). Mean weekly time in moderate and vigorous activity was 32 min (SD=54) at baseline which increased by 75% to a mean of 56 min (SD=87) at the 3-month follow-up, however, this change was not statistically significant (p=0.063, 95% CI -1.4 to 52). The mean EQ5D-VAS score was significantly increased from 39 (SD=15) to 60 (SD=20) (p < 0.001, 95% CI 8 to 26) after 3 months.
Conclusions
Treatment with SCS reduces chronic neuropathic pain intensity. Pain relief appears to positively affect physical activity level, which may contribute to increased HRQL. Among patients participating in the trial, time spent in physical activity increased with 75% after 3 months of SCS treatment. The substantial cross-over from conventional medical treatment to the SCS group indicates that the experienced pain relief can be of clinical significance for patients, despite rather modest decrease of NRS baseline values.
References
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Presenting Author
Raquel Gottfridsson
Poster Authors
Raquel Gottfridsson
MD, PhD student
Institute of Clinical Sciences, University of Gothenburg, Sweden
Lead Author
Kliment Gatzinsky
Institute of Neuroscience and Physiology, University of Gothenburg
Lead Author
Emma Varkey
Sahlgrenska Universitetsjukhuset/Östra
Lead Author
Axel Wolf
Institute of Health and Care Sciences, University of Gothenburg
Lead Author
Jaquette Liljencrantz
Institution of Clinical Sciences, University of Gothenburg
Lead Author
Paulin Andréll
Institution of Clinical Sciences, University of Gothenburg
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Neuropathic Pain - Peripheral