Neurostimulation for Chronic Pain: A Systematic Review of High-Quality Randomized Controlled Trials With Long-Term Follow-Up

Yilong Zheng; Christopher Weiyang Liu; Diana Xin Hui Chan; Damian Wen Kai Ong; Justin Rui Xin Ker; Wai Hoe Ng; Kai Rui Wan

doi:10.1016/j.neurom.2023.05.003

Neurostimulation for Chronic Pain: A Systematic Review of High-Quality Randomized Controlled Trials With Long-Term Follow-Up

Neuromodulation. 2023 Oct;26(7):1276-1294. doi: 10.1016/j.neurom.2023.05.003. Epub 2023 Jul 10.

Authors

Yilong Zheng¹, Christopher Weiyang Liu², Diana Xin Hui Chan², Damian Wen Kai Ong³, Justin Rui Xin Ker⁴, Wai Hoe Ng⁴, Kai Rui Wan⁵

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
² Anaesthesiology and Pain Management, Singapore General Hospital, Singapore.
³ Anaesthesia & Chronic and Interventional Pain Management, Tan Tock Seng Hospital, Singapore.
⁴ Department of Neurosurgery, National Neuroscience Institute, Singapore.
⁵ Department of Neurosurgery, National Neuroscience Institute, Singapore. Electronic address: wan.kai.rui@singhealth.com.sg.

PMID: 37436342
DOI: 10.1016/j.neurom.2023.05.003

Abstract

Objective: This study aimed to review the best evidence on the long-term efficacy of neurostimulation for chronic pain.

Materials and methods: We systematically reviewed PubMed, CENTRAL, and WikiStim for studies published between the inception of the data bases and July 21, 2022. Randomized controlled trials (RCTs) with a minimum of one-year follow-up that were of high methodologic quality as ascertained using the Delphi list criteria were included in the evidence synthesis. The primary outcome was long-term reduction in pain intensity, and the secondary outcomes were all other reported outcomes. Level of recommendation was graded from I to III, with level I being the highest level of recommendation.

Results: Of the 7119 records screened, 24 RCTs were included in the evidence synthesis. Therapies with recommendations for their usage include pulsed radiofrequency (PRF) for postherpetic neuralgia, transcutaneous electrical nerve stimulation for trigeminal neuralgia, motor cortex stimulation for neuropathic pain and poststroke pain, deep brain stimulation for cluster headache, sphenopalatine ganglion stimulation for cluster headache, occipital nerve stimulation for migraine, peripheral nerve field stimulation for back pain, and spinal cord stimulation (SCS) for back and leg pain, nonsurgical back pain, persistent spinal pain syndrome, and painful diabetic neuropathy. Closed-loop SCS is recommended over open-loop SCS for back and leg pain. SCS is recommended over PRF for postherpetic neuralgia. Dorsal root ganglion stimulation is recommended over SCS for complex regional pain syndrome.

Conclusions: Neurostimulation is generally effective in the long term as an adjunctive treatment for chronic pain. Future studies should evaluate whether the multidisciplinary management of the physical perception of pain, affect, and social stressors is superior to their management alone.

Keywords: Drug-resistant pain; guideline; intractable pain; neuromodulation; refractory pain.

Publication types

Review