Patient Satisfaction With Spinal Cord Stimulation and Dorsal Root Ganglion Stimulation for Chronic Intractable Pain: A Systematic Review and Meta-Analysis

Objectives: In the spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRG-S) literature, the typical primary outcome measure includes pain relief, whether numeric rating scale changes or percentage pain relief, and functional outcomes and patient satisfaction are included as secondary outcomes. This systematic review and meta-analysis aims to determine the rate of patient satisfaction with the use of SCS and DRG-S in the treatment of chronic intractable pain.

Materials And Methods: The study protocol was registered in the PROSPERO International prospective register of systematic reviews. We queried articles from multiple electronic data bases, including MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials data bases, and hand-searched reference lists of identified publications. All periods were included. Inclusion criteria encompassed randomized controlled trials (RCTs) and prospective observational studies that reported patient satisfaction in patients who underwent SCS or DRG-S. Bias evaluation for the included studies involved appropriate guidelines for each study design (Cochrane risk of bias tool for RCTs and Newcastle-Ottawa scale for observational studies).

Results: Our search strategy identified 242 unique citations, of which nine RCTs and 23 observational studies were included for analysis. Overall, 25 studies comprising 1355 participants were pooled in our quantitative analysis. The pooled proportion of patients who reported satisfaction from all studies was 82.2% (95% CI, 77.8%-86.2%). This finding had high statistical heterogeneity (I = 74.0%). Subgroup analysis did not reveal differences in satisfaction when studies were stratified based on study design (RCT or observational study) or follow-up period (six, 12, 24, and 36 months).

Conclusions: Our results show high levels of patient satisfaction across the SCS and DRG-S literature when these treatment modalities are used for chronic intractable pain, regardless of SCS programming algorithm. However, there is a scarcity of unbiased and/or non-industry-funded prospective studies in the neuromodulation field, and future efforts to expand this area of the SCS and DRG-S literature are greatly needed.