Systematic Review and Meta-Analysis of Spinal Cord Stimulation for Chronic Nonsurgical Refractory Back Pain With or Without Leg Pain (Persistent Spinal Pain Syndrome Type 1)

Objectives:

The aim of this systematic review and meta-analysis was to evaluate the safety and effectiveness of spinal cord stimulation (SCS) on pain intensity, physical function, and health-related quality of life (HRQoL) for people experiencing persistent spinal pain syndrome type 1 (PSPS-T1), also known as nonsurgical refractory back pain with or without leg pain, and to assess the durability of SCS treatment effects. 

Materials and Methods:

MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and WikiStim data bases were searched from inception to December 19, 2024. Eligible studies included randomized controlled trials (RCTs) with any follow-up duration, and non-RCTs with ≥12-month follow-up. Outcomes included pain intensity, physical function, and HRQoL. Risk of bias was assessed using the revised Cochrane risk-of-bias and National Institutes of Health tools. Certainty of the evidence for the comparisons and outcomes included in the meta-analysis was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. The measure of treatment effect was mean difference (MD) or odds ratio and 95% CI. 

Results:

Overall, 19 reports of 16 unique studies were included in the review. Meta-analysis shows significant reductions in pain with SCS compared with conventional medical management (CMM) at six-month follow-up (MD 5.67; 95% CI: 4.60–6.74). Statistically significant results in favor of SCS compared with CMM were observed for physical function and HRQoL. Meta-analysis of non-RCT data showed significant improvements in pain intensity, physical function, and HRQoL up to 24 months compared with baseline. 

Conclusions:

All included studies of SCS for PSPS-T1 indicated significant improvements in pain intensity, physical function, and HRQoL when compared with CMM or baseline.