Skip to main content
SpringerLink
Log in

Cost-Effectiveness of Interventional Techniques

  • Chapter
  • First Online:
Treatment of Chronic Pain by Interventional Approaches

  • 2374 Accesses

Abstract

The field of neurostimulation has matured over the past decade to emerge as an important modality for the treatment of intractable chronic pain. Despite relatively high initial costs, a breadth of evidence exists, and extensive clinical experience suggests that spinal cord stimulation and intrathecal drug delivery systems are safe, effective, and economical. The benefits of neuromodulation are manifested in improved functional capability, health-related quality of life (HRQoL), and reduced demand for health-care resources. This results in long-term economic benefit and cost saving. Neuromodulation is a viable option for the early treatment of patients with intractable pain syndromes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. De Andres JM, Van Buyten JP. Neural modulation by stimulation. Pain Pract. 2006;6(1):39–45.

    Article  PubMed  Google Scholar 

  2. Grabow TS, Tella PK, Raja SN. Spinal cord stimulation for complex regional pain syndrome: an evidence-based medicine review of the literature. Clin J Pain. 2003;19(6):371–83.

    Article  PubMed  Google Scholar 

  3. Harke H, Gretenkort P, Ladleif HU, et al. Spinal cord stimulation in sympathetically maintained complex regional pain syndrome type I with severe disability. A prospective clinical study. Eur J Pain. 2005;9(4):363–73.

    Article  PubMed  Google Scholar 

  4. Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132(1–2):179–88.

    Article  PubMed  Google Scholar 

  5. Kumar K, Taylor RS, Jacques L, et al. The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the PROCESS trial. Neurosurgery. 2008;63:762–70.

    Article  PubMed  Google Scholar 

  6. Manca A, Kumar K, Taylor RS, et al. Quality of life, resource consumption and costs of spinal cord simulation versus conventional medical management in neuropathic pain patients with failed back surgery syndrome (PROCESS trial). Eur J Pain. 2008;12:1047–58.

    Article  PubMed  Google Scholar 

  7. North RB, Kidd DH, Zahurak M, James CS, et al. Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery. 1993;32(3):384–94; discussion 394–95.

    Article  CAS  PubMed  Google Scholar 

  8. North RB, Kidd DH, Farrokhi F. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56:98–107.

    PubMed  Google Scholar 

  9. North RB, Kidd DH, Shipley J, et al. Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery. 2007;61:361–9.

    Article  PubMed  Google Scholar 

  10. Kemler MA, Furnee CA. Economic evaluation of spinal cord stimulation for chronic reflex sympathetic dystrophy. Neurology. 2002;59(8):1203–9.

    Article  PubMed  Google Scholar 

  11. Kemler MA. The cost-effectiveness of spinal cord stimulation for complex regional pain syndrome. Value Health. 2010;13(6):735–42.

    Article  PubMed  Google Scholar 

  12. Mailis-Gagnon A, Furlan AD, Sandoval JA, Taylor R. Spinal cord stimulation for chronic pain. Cochrane Database Syst Rev. 2004;(3):CD003783.

    Google Scholar 

  13. Stanton-Hicks M. Complex regional pain syndrome: manifestations and the role of neurostimulation in its management. J Pain Symptom Manage. 2006;31(4S):20–4.

    Article  Google Scholar 

  14. Taylor RJ, Taylor RS. Spinal cord stimulation for failed back surgery syndrome: a decision-analytic model and cost-effectiveness analysis. Int J Technol Assess Health Care. 2005;21:351–8.

    Article  PubMed  Google Scholar 

  15. Taylor RS, Buyten JPV, Buchser E. Spinal cord stimulation for complex regional pain syndrome: a systematic review of the clinical and cost-effectiveness literature and assessment of prognostic factors. Eur J Pain. 2006;10(2):91–101.

    Article  PubMed  Google Scholar 

  16. Kumar K, Malik S, Demeria D. Treatment of chronic pain with spinal cord stimulation versus alternative therapies: cost-effectiveness analysis. Neurosurgery. 2002;51(1):106–16.

    Article  PubMed  Google Scholar 

  17. Kumar K, Bishop S. Financial impact of spinal cord stimulation on the healthcare budget: a comparative analysis of costs in Canada and the United States. J Neurosurg. 2009;10:564–73.

    Google Scholar 

  18. Tesfaye S, Watt J, Benbow SJ, Pang KA, Miles J, MacFarlane IA. Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy. Lancet. 1996;348(9043):1698–701.

    Article  CAS  PubMed  Google Scholar 

  19. Jivegard LEH, Augustinsson LE, Holm J, Risberg B, Örtenwall P. Effects of spinal cord stimulation (SCS) in patients with inoperable severe lower limb ischaemia: a prospective randomised controlled study. Eur J Vasc Endovasc Surg. 1995;9(4):421–5.

    Article  CAS  PubMed  Google Scholar 

  20. Hautvast RWM, DeJongste MJL, Staal MJ, van Gilst WH, Lie KI. Spinal cord stimulation in chronic intractable angina pectoris: a randomized, controlled efficacy study. Am Heart J. 1998;136(6):1114–20.

    Article  CAS  PubMed  Google Scholar 

  21. 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. 1998;50(2):110–20.

    Article  CAS  PubMed  Google Scholar 

  22. May MS, Banks C, Thomson SJ. A retrospective, long-term, third-party follow-up of patients considered for spinal cord stimulation. Neuromodulation. 2002;5(3):137–44.

    Article  PubMed  Google Scholar 

  23. National Institute for Clinical Excellence. Pain (chronic neuropathic or ischaemic) - spinal cord stimulation: guidance (TA159). London: National Institute for Clinical Excellence; 2008.

    Google Scholar 

  24. Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299:656–64.

    Article  CAS  PubMed  Google Scholar 

  25. Hazard RG. Failed back surgery syndrome: surgical and nonsurgical approaches. Clin Orthop Relat Res. 2006;443:228–32.

    Article  PubMed  Google Scholar 

  26. Kemler MA, Barendse GA, Van Kleef M, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 2000;343:618–24.

    Article  CAS  PubMed  Google Scholar 

  27. Melzack R. Pain mechanisms: a new theory. Science. 1965;150(699):971–9.

    Article  CAS  PubMed  Google Scholar 

  28. Roberts MH, Rees H. Physiological basis of spinal cord stimulation. Pain Rev. 1994;1:184–98.

    Google Scholar 

  29. Raslan AM, McCartney S, Burchiel KJ. Management of chronic severe pain: spinal neuromodulatory and neuroablative approaches. Acta Neurochir Suppl. 2007;97(1):33–41.

    CAS  PubMed  Google Scholar 

  30. Dubuisson D. Effect of dorsal-column stimulation on gelatinosa and marginal neurons of cat spinal cord. J Neurosurg. 1989;70(2):257–65.

    Article  CAS  PubMed  Google Scholar 

  31. Cui J, O’Connor W, Ungerstedt U, Linderoth B, Meyerson B. Spinal cord stimulation attenuates augmented dorsal horn release of excitatory amino acids in mononeuropathy via a GABAergic mechanism. Pain. 1997;73(1):87–95.

    Article  CAS  PubMed  Google Scholar 

  32. Wallin J, Cui JG, Yakhnitsa V, Schechtmann G, Meyerson BA, Linderoth B. Gabapentin and pregabalin suppress tactile allodynia and potentiate spinal cord stimulation in a model of neuropathy. Eur J Pain. 2002;6(4):261–72.

    Article  CAS  PubMed  Google Scholar 

  33. Krames E. Overview of spinal cord stimulation: with special emphasis on a role for dual spinal cord stimulators. Pain Digest. 2000;10:6–12.

    Google Scholar 

  34. Holsheimer J, Wesselink WA. Effect of anode-cathode configuration on paresthesia coverage in spinal cord stimulation. Neurosurgery. 1997;41:654–60.

    CAS  PubMed  Google Scholar 

  35. North RB, Ewend ME, Lawton MA, et al. Spinal cord stimulation for chronic, intractable pain: superiority of `multi-channel’ devices. Pain. 1991;44(2):119–30.

    Article  CAS  PubMed  Google Scholar 

  36. Barolat G, Massaro F, He J, et al. Mapping of sensory responses to epidural stimulation of the intraspinal neural structures in man. J Neurosurg. 1993;78(2):233–9.

    Article  CAS  PubMed  Google Scholar 

  37. Shatin D, Mullett K, Hults G. Totally implantable spinal cord stimulation for chronic pain: design and efficacy. Pacing Clin Electrophysiol. 1986;9:577–83.

    Article  CAS  PubMed  Google Scholar 

  38. Hornberger J, Kumar K, Verhulst E, et al. Rechargeable spinal cord stimulation versus non-rechargeable system for patients with failed back surgery syndrome: a cost-consequence analysis. Clin J Pain. 2009;24:244–52.

    Article  Google Scholar 

  39. North RB, Shipley J, Prager J. Practice parameters for the use of spinal cord stimulation in the treatment of chronic neuropathic pain. Pain Med. 2007;8(4):S200–75.

    Article  PubMed  Google Scholar 

  40. Barolat G, Sharan AD. Future trends in spinal cord stimulation. Neurol Res. 2000;22:279–84.

    CAS  PubMed  Google Scholar 

  41. 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. 2006;58:481–96.

    Article  PubMed  Google Scholar 

  42. Wang J, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology. 1979;50:149–51.

    Article  CAS  PubMed  Google Scholar 

  43. Behar M, Magora F, Olshwang D, et al. Epidural morphine in treatment of pain. Lancet. 1979;1:527.

    Article  CAS  PubMed  Google Scholar 

  44. Lund PC. Reflections upon the historical aspects of spinal anesthesia. Reg Anesth. 1983;8:89–98.

    Google Scholar 

  45. Ghafoor VL, Epshteyn M, Carlson GH, Terhaar DM, Charry O, Phelps PK. Intrathecal drug therapy for long-term pain management. Am J Health Syst Pharm. 2007;64(23):2447.

    Article  CAS  PubMed  Google Scholar 

  46. Prager J, Jacobs M. Evaluation of patients for implantable pain modalities: medical and behavioral assessment. Clin J Pain. 2001;17:206–14.

    Article  CAS  PubMed  Google Scholar 

  47. Krames ES, Olson K. Clinical realities and economic considerations: patient selection in intrathecal drug therapy. J Pain Symptom Manage. 1997;14:S3–13.

    Article  CAS  PubMed  Google Scholar 

  48. Krames ES. Spinal administration of opioids and other analgesic compounds. In: Waldman SD, editor. Interventional pain management. 2nd ed. Philadelphia: W. B. Saunders; 2001. p. 593–603.

    Google Scholar 

  49. Lance JW. Synopsis. In: Feldman RG, Young RR, Koella WP, editors. Spasticity: disordered motor control. Chicago: Year Book Medical Publishers; 1980. p. 480–5.

    Google Scholar 

  50. Sanger TD, Delgado MR, Gaebler-Spira D, Hallet M, Mink JW, Task Force on Childhood Motor Disorders. Classification and definition of disorders causing hypertonia in childhood. Pediatrics. 2003;111(1):e89–97.

    Article  PubMed  Google Scholar 

  51. Francisco GC, Boake C. Improvement in walking speed in poststroke spastic hemiplegia after intrathecal baclofen therapy: a preliminary study. Arch Phys Med Rehabil. 2003;84(8):1194–9.

    Article  PubMed  Google Scholar 

  52. Meythaler JM, Guin-Refroe S, Brunner RC, Hadley MN. Intrathecal baclofen for spastic hypertonia from stroke. Stroke. 2001;32(9):2099–109.

    Article  CAS  PubMed  Google Scholar 

  53. Ivanhoe CB, Francisco GE, McGuire JR, Subramanian T, Grissom SP. Intrathecal baclofen management of poststroke spastic hypertonia: implications for function and quality of life. Arch Phys Med Rehabil. 2006;87(11):1509–15.

    Article  PubMed  Google Scholar 

  54. Gilmartin R. Intrathecal baclofen for management of spastic cerebral palsy: multicenter trial. J Child Neurol. 2000;15(2):71–7.

    Article  CAS  PubMed  Google Scholar 

  55. Penn RD. Intrathecal baclofen for spasticity of spinal origin: seven years of experience. J Neurosurg. 1992;77(2):236–40.

    Article  CAS  PubMed  Google Scholar 

  56. Albright AL, Gilmartin R, Swift D, Krach LE, Ivanhoe CB, McLaughlin JF. Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin. J Neurosurg. 2003;98(2):291–5.

    Article  CAS  PubMed  Google Scholar 

  57. Coffey RJ, Cahill D, Steers W. Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study. J Neurosurg. 1993;78(6):226–32.

    Article  CAS  PubMed  Google Scholar 

  58. Ordia JI, Fischer E, Adamski E, Chagnon KG, Spatz EL. Continuous intrathecal baclofen infusion by a programmable pump in 131 consecutive patients with severe spasticity of spinal origin. Neuromodulation. 2002;5(1):16–24.

    Article  PubMed  Google Scholar 

  59. Becker R, Alberti O, Bauer BL. Continuous intrathecal baclofen infusion in severe spasticity after traumatic or hypoxic brain injury. J Neurol. 1997;224(3):160–6.

    Article  Google Scholar 

  60. Clinical reference guide. Intrathecal baclofen for the management of severe spasticity. Minneapolis: Medtronic; 2004.

    Google Scholar 

  61. Dario A, Tomei G. A benefit-risk assessment of baclofen in severe spinal spasticity. Drug Saf. 2004;27:799–818.

    Article  CAS  PubMed  Google Scholar 

  62. Intrathecal drug delivery for the management of pain and spasticity in adults; Recommendations for best clinical practice. British Pain Society. Grady K, Raphael J editors. British Pain Society. 2008. http://www.britishpainsociety.org/book_ittd_main.pdf. Web 8 Aug 2010.

  63. Mercadante S. Problems of long-term spinal opioid treatment in advanced cancer patients. Pain. 1999;79:1–13.

    Article  CAS  PubMed  Google Scholar 

  64. Heruth K. Medtronic synchromed drug administration system. Annals of the New York Academy of Sciences 1988;531:72–75.

    Google Scholar 

  65. Bennett G, Burchiel K, Buchser E, et al. Clinical guidelines for intraspinal infusion: report of an expert panel. J Pain Symptom Manage. 2000;20:S37–43.

    Article  CAS  PubMed  Google Scholar 

  66. Hassenbusch SJ, Portenoy RK. Current practices in intraspinal therapy – a survey of clinical trends in decision making. J Pain Symptom Manage. 2000;20:S4–11.

    Article  CAS  PubMed  Google Scholar 

  67. Hassenbusch S, Portenoy RK, Cousins M, et al. Polyanalgesic consensus conference 2003: an update on the management of pain by intraspinal drug delivery – report of an expert panel. J Pain Symptom Manage. 2004;27:540–63.

    Article  PubMed  Google Scholar 

  68. Deer T, Krames ES, Hassenbusch SJ, et al. Polyanalgesic consensus conference 2007: recommendations for the management of pain by intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation. 2007;10:300–28.

    Article  PubMed  Google Scholar 

  69. Postma TJ, Oenema D, Terpstra S, Bouma J, Keipers-Upmeier H, Staal MJ, Middel B. Cost analysis of the treatment of severe spinal spasticity with continuous intrathecal baclofen infusion system. Pharmacoeconomics. 1999;15:395–404.

    Article  CAS  PubMed  Google Scholar 

  70. Sampson FC, Hayward A, Evans G, Morton R, Collett B. Functional benefits and cost/benefit analysis of continuous intrathecal baclofen infusion for the management of severe spasticity. J Neurosurg. 2002;96:1052–7.

    Article  PubMed  Google Scholar 

  71. Hassenbusch SJ, Paice JA, Patt RB, et al. Clinical realities and economic considerations: economics of intrathecal drug therapy. J Pain Symptom Manage. 1997;14:S36–48.

    Article  CAS  PubMed  Google Scholar 

  72. Kumar K, Hunter G, Demeria DD. Treatment of chronic pain by using intrathecal drug therapy compared with conventional pain therapies: a cost effectiveness analysis. J Neurosurg. 2002;97:803–10.

    Article  PubMed  Google Scholar 

  73. Kumar K, Bodani V, Bishop S, Tracey S. Use of intrathecal bupivacaine in refractory chronic nonmalignant pain. Pain Med. 2009;10:819–28.

    Article  PubMed  Google Scholar 

  74. Royal MA, Wiesemeyer DL, Gordin V. Intrathecal opioid conversions: the importance of lipophilicity. Neuromodulation. 1998;1:195–7.

    Article  CAS  PubMed  Google Scholar 

  75. Yaksh TL, Rudy TA. Narcotic analgesia produced by a direct action on the spinal cord. Science. 1976;192:1357–8.

    Article  CAS  PubMed  Google Scholar 

  76. Cousins MJ, Mather LE, Glynn CJ, Wilson PR, Graham JR. Selective spinal analgesia. Lancet. 1979;1:1141–2.

    Article  CAS  PubMed  Google Scholar 

  77. Gourlay GK, Cherry DA, Cousins MJ. Cephalad migration of morphine in CSF following lumbar epidural administration in patients with cancer pain. Pain. 1985;23:317–26.

    Article  CAS  PubMed  Google Scholar 

  78. Dickenson AH. Recent advances in the physiology and pharmacology of pain: plasticity and its implications for clinical analgesia. J Psychopharmacol. 1991;5:342–51.

    Article  CAS  PubMed  Google Scholar 

  79. Eisenach JC. Three novel spinal analgesics: clonidine, neostigmine, amitriptyline. Reg Anesth. 1996;21:81–3.

    CAS  PubMed  Google Scholar 

  80. Staats P. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS. JAMA. 2004;291:63–70.

    Article  CAS  PubMed  Google Scholar 

  81. Yaksh TL. Pharmacology of spinal adrenergic systems which modulate spinal nociceptive processing. Pharmacol Biochem Behav. 1985;22:845–58.

    Article  CAS  PubMed  Google Scholar 

  82. National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. London: National Institute for Health and Clinical Excellence; 2004.

    Google Scholar 

  83. Kumar K, Abbas M, Rizvi S. The use of spinal cord stimulation in pain management. Pain Management. 2012;2:2, 125–134.

    Google Scholar 

  84. Turner JA, Sears JM, Loeser JD. Programmable intrathecal opioid delivery systems for chronic non-malignant pain: a systematic review of effectiveness and complications. Clin J Pain. 2007;23:180–95.

    Article  PubMed  Google Scholar 

  85. Bennett G, Deer T, Du Pen S, et al. Future directions in the management of pain by intraspinal drug delivery. J Pain Symptom Manage. 2000;20:S44–50.

    Article  CAS  PubMed  Google Scholar 

  86. Deer TR, Krames E, Levy RM, Hassenbusch SJ, Prager JP. Practice choices and challenges in the current intrathecal drug therapy environment: an online survey. Pain Med. 2009;10:304–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Regina General Hospital, University of Saskatchewan, Medical Office Wing, 1440-14th Ave, Regina, SK, S4P 0W5, Canada

    Krishna Kumar M.B.B.S., M.S., FRCSC

  2. Department of Neurosurgery, Regina General Hospital, c/o Dr. Kumar, 1440-14th Ave, Regina, SK, S4P 0W5, Canada

    Syed Rizvi M.D.

  3. Department of Neurosurgery, Unit 5A, Regina General Hospital, 1440-14th Ave, Regina, SK, S4P 0W5, Canada

    Sharon Bishop BScN, MHlthSci

  4. Department of Neurosurgery, Regina General Hospital, 1440-14th Ave, Regina, SK, S4P 0W5, Canada

    Mariam Abbas

Authors
  1. Krishna Kumar M.B.B.S., M.S., FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Syed Rizvi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sharon Bishop BScN, MHlthSci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mariam Abbas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Krishna Kumar M.B.B.S., M.S., FRCSC .

Editor information

Editors and Affiliations

  1. President and CEO, Clinical Professor of Anesthesiology, The Center for Pain Relief, West Virginia University School of Medicine, Charleston, West Virginia, USA

    Timothy R. Deer

  2. Clinic Chief, Clinical Associate Professor, Department of Anesthesiology, Stanford Pain Medicine Center, Redwood City, CA, USA, and Stanford University School of Medicine, Stanford, California, USA

    Michael S. Leong

  3. Department of Anesthesiology, Orthopedic Anesthesia, Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA

    Asokumar Buvanendran

  4. Center for Interventional Pain & Spine, DE and Bryn Mawr, Newark, Pennsylvania, USA

    Philip S. Kim

  5. President, National Institute of Pain, Tampa, Florida, USA

    Sunil J. Panchal

Rights and permissions

Reprints and permissions

Copyright information

© 2015 American Academy of Pain Medicine

About this chapter

Cite this chapter

Kumar, K., Rizvi, S., Bishop, S., Abbas, M. (2015). Cost-Effectiveness of Interventional Techniques. In: Deer, T., Leong, M., Buvanendran, A., Kim, P., Panchal, S. (eds) Treatment of Chronic Pain by Interventional Approaches. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1824-9_47

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1824-9_47

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1823-2

  • Online ISBN: 978-1-4939-1824-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation