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Advanced neuromodulation reduces biological pain intensity in persistent spinal pain syndrome type 2. However, it fails to spontaneously decrease long-term opioid consumption.
Chronic pain following spine surgery remains a challenging clinical problem, requiring treatment strategies that address more than pain intensity alone. A systematic review and network meta-analysis exploring pharmacological, interventional, and rehabilitative approaches found that spinal cord stimulation (SCS) + conventional medical management (CMM) markedly improved the likelihood of attaining substantial pain relief. However, this benefit did not translate into reduced long-term opioid use in a large real-world cohort.
Researchers searched the MEDLINE, Embase, and Cochrane databases for studies issued up to April 15, 2026. Of 1,452 records screened, 100 studies were incorporated in the qualitative synthesis, while 24 randomised controlled trials and high-quality cohort studies contributed to the quantitative meta-analysis. The major findings were:
The findings support a shift from a predominantly mechanical approach to chronic postsurgical spine pain towards multidisciplinary care that integrates neuromodulation, rehabilitation, medication management, and psychological support. Although SCS can yield substantial pain relief, it must not be assumed to minimize opioid dependence or long-term opioid exposure. The authors emphasised the importance of early functional restoration and a holistic, biopsychosocial approach to treatment, with pain control and opioid reduction addressed as distinct therapeutic goals.
Cureus
Treatment Options for Chronic Pain After Spine Surgery: A Systematic Review and Meta-Analysis of Interventional, Pharmacological, and Rehabilitative Strategies
Alok G Belgaumkar et al.
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