PURPOSE: Chronic pain affects more than 80% of individuals with spinal cord injury (SCI), profoundly impairing mobility, rehabilitation, and quality of life. Conventional pharmacologic and non-pharmacologic treatments often fail to achieve adequate relief. Spinal cord stimulation (SCS) has emerged as a potential neuromodulatory therapy for neuropathic pain; however, its role in SCI remains insufficiently defined.
PATIENTS AND METHODS: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered with PROSPERO (CRD42024541622). Comprehensive searches of PubMed, Embase, Web of Science, and the Cochrane Library were performed through April 2024. Eligible studies evaluated SCS for chronic pain in adults with SCI and reported validated pain or patient-reported outcomes. Screening, eligibility assessment, and data extraction were performed in duplicate. Risk of bias and certainty of evidence were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and the MethodologicAl STandards for Epidemiological Research (MASTER) tool.
RESULTS: From 1064 records, 10 studies involving 43 participants met inclusion criteria. Most were case reports or small case series, with one prospective cohort study. All studies reported pain improvement after SCS using heterogenous outcome formats; minor adverse events were reported in 3 studies, and the remaining 7 studies reported none. The overall certainty of evidence was rated very low due to small sample sizes, heterogeneity in study design, and methodological limitations. Three ongoing clinical trials evaluating SCS for pain in SCI were also identified.
CONCLUSION: Preliminary, very low-certainty evidence indicates that SCS may be a promising option for chronic pain after SCI, with limited reported complications in the available literature. Higher-quality studies are required to confirm benefit, characterize risks, and guide patient selection and programming.
PROSPERO REGISTRATION NUMBER: CRD42024541622.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
The results suggest pain improvement in all studies included, often clinically relevant, with few adverse events. However, most are case reports or small case series, resulting in a very low level of evidence and significant heterogeneity, which hampers robust quantitative analyses. Prospective, randomized studies are needed to clarify the true efficacy of SCS and identify patients who may benefit most.
, McMaster University