Physical functioning following spinal cord stimulation: a systematic review and meta-analysis

Area of Science:

• Neurology
• Pain Management
• Rehabilitation Medicine

Background:

• Spinal cord stimulation (SCS) is a recognized treatment for chronic pain.
• Evidence for SCS's impact on pain intensity exists, but its effect on physical functioning requires synthesis.
• This meta-analysis focuses on long-term physical function outcomes after 12 months of SCS for chronic back pain.

Approach:

• A comprehensive literature search was conducted across PubMed, EMBASE, Scopus, and CENTRAL databases.
• Original peer-reviewed studies investigating physical function post-SCS were included.
• A random effects model and the GRADE framework were employed to analyze data and assess evidence certainty.

Key Points:

• 36 studies were included, with 22 contributing to the meta-analysis.
• Significant improvement in Oswestry Disability Index (ODI) scores was observed at 12 months (mean difference: -17.00%, p<0.001).
• Evidence certainty was rated as very low, with high heterogeneity noted.

Conclusions:

• Spinal cord stimulation demonstrates significant improvements in physical function for chronic back pain.
• The observed benefits are limited by very low GRADE certainty of evidence and substantial heterogeneity.
• Further high-quality research is needed to confirm these findings and understand influencing factors.