A NEW systematic review and network meta-analysis has demonstrated that spinal cord stimulation (SCS), both conventional and novel forms, is more effective than conventional medical management (CMM) for chronic pain relief at six months across most evaluated outcomes.
Chronic pain in the back and lower extremities is a significant global health challenge, often leading to disability and reduced quality of life. Spinal cord stimulation, a minimally invasive intervention, has been proposed as an alternative to conventional treatments for individuals with refractory chronic pain. This study aimed to synthesise and evaluate the latest evidence comparing the efficacy of SCS therapies with standard CMM approaches.
A systematic search of MEDLINE, Embase, and the Cochrane Library identified 13 randomised clinical trials involving 1561 patients. A Bayesian network meta-analysis was conducted, estimating odds ratios (ORs) and mean differences (MDs) with credible intervals (CrI) for six key outcomes, including pain intensity, responder rates, quality of life, and functional disability. Both conventional and novel SCS therapies outperformed CMM. For back pain responder rates, conventional SCS showed an OR of 3.00 (95% CrI, 1.49–6.72), while novel SCS demonstrated an OR of 8.76 (95% CrI, 3.84–22.31). Novel SCS also showed greater reductions in back pain intensity (MD, −2.34; 95% CrI, −2.96 to −1.73) compared with conventional SCS (MD, −1.17; 95% CrI, −1.64 to −0.70). Quality of life improvements were similar across SCS types, with increases in EQ-5D index scores. Functional disability outcomes significantly favoured conventional SCS over CMM (MD, −7.10; 95% CrI, −10.91 to −3.36).
In conclusion, this analysis supports the superior efficacy of SCS therapies over CMM in managing chronic back and lower extremity pain, particularly in improving pain relief and quality of life. While both conventional and novel SCS were effective, novel SCS demonstrated the greatest impact on pain intensity. These findings underscore the potential role of SCS as a valuable treatment option in clinical practice. Future research should explore long-term outcomes, cost-effectiveness, and optimal patient selection criteria to maximise the clinical utility of SCS therapies.
Reference
Huygen FJPM et al. Spinal Cord stimulation vs medical management for chronic back and leg pain: a systematic review and network meta-analysis. JAMA Netw Open. 2024;7(11):e2444608.
