Effectiveness of spinal cord stimulation in chronic pain :- Medznat

Chronic pain remains a key global healthcare burden, requiring targeted interventional strategies when conservative regimens fail.

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Key take away

Spinal cord stimulation improves chronic pain relief and health-related quality of life when compared to conventional medical management.

Background

Chronic pain remains a key global healthcare burden, requiring targeted interventional strategies when conservative regimens fail. Although spinal cord stimulation (SCS) is widely utilized, previous systematic reviews and meta-analyses have largely excluded head-to-head direct comparisons among distinct SCS modalities. This major gap leaves current clinical literature susceptible to substantial publication bias and restricts comparative effectiveness decisions.

To address these shortcomings, this systematic review and network meta-analysis (NMA) pooled direct and indirect randomized clinical trial evidence to determine the therapeutic impacts of SCS on pain intensity, physical functional impairment, and health-related quality of life (HRQoL).

Method

MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and WikiStim were searched from database inception through December 19, 2024. The review included parallel-arm randomized trials comparing SCS with CMM, active interventions—including other SCS modalities—or placebo in adults with chronic pain.

The analysis included 23 reports representing 16 unique randomized trials. Pain intensity, physical function, and HRQoL were assessed via mean differences (MDs) and 95% confidence intervals (CIs), while treatment response was evaluated via odds ratios (ORs) and 95% CIs. Treatment response was defined as a reduction of at least 50% in pain intensity. A frequentist NMA framework was employed to integrate direct and indirect treatment comparisons.

Result

Pain intensity: All SCS modalities substantially reduced pain scores vs. CMM (mean difference [MD]: −2.37 to −5.55 on a 0–10 scale; 15 trials, 1,479 subjects; low-certainty evidence).
Physical function: Improvements varied across comparisons (MD: −0.20 to −31.04; 8 trials, 837 subjects; low-certainty evidence).
QoL: SCS improved HRQoL at 6 months (MD: 0.15–0.29; 8 trials, 942 subjects; moderate-certainty evidence).
Treatment response: SCS elevated the odds of attaining at least 50% pain reduction (odds ratio [OR]: 9.75–63.4; 13 trials, 1,887 subjects; very low-certainty evidence).

All but one included trial had a high risk of bias.

Conclusion

SCS illustrated benefits over CMM for chronic pain, with evidence of reduced pain intensity, improved HRQoL, and higher odds of clinically meaningful pain relief. However, functional improvements vary across comparisons, and the high risk of bias and low certainty of evidence for several outcomes warrant cautious interpretation.