Systematic Review to Identify Patient-Level Predictors of Treatment Response to Spinal Cord Stimulation for...

Chronic neuropathic pain is challenging to manage, but one recommended treatment is spinal cord stimulation (SCS), which may provide pain relief and improvements in physical function and health-related quality of life. Almost half of the patients do not obtain long-term relief, and selection of appropriate patients can be problematic. The objective of this study was to undertake a systematic review of the contemporary evidence base for patient-level predictors for the outcomes from all types of SCS.

A literature search of MEDLINE, EMBASE, CINAHL, and WikiStim was conducted to identify contemporary SCS studies published from 2012 to 2024. Study selection, data extraction, and risk-of-bias (RoB) assessment using the Quality in Prognosis Studies tool were performed by two independent reviewers.

A total of 40 studies were included in the review; 28 studies (70%) had high RoB; seven (17.5%) had medium RoB, and five (12.5%) had low RoB. We found no strong evidence of an association between the studied patient-level factors and treatment outcomes, with conflicting results for most patient factors. Confidence in the evidence is limited because the quality of the assessed evidence ranged from low to very low, with a high RoB for most of the included studies.

Access to individual patient data and prospective data collection including the use of large real-world registries with full population inclusion is required to identify potential patient-level factors, thus facilitating future patient selection and enhancing treatment outcomes.