• Yilong Zheng, Christopher Weiyang Liu, Hui ChanDiana XinDXAnaesthesiology and Pain Management, Singapore General Hospital, Singapore., Damian Wen Kai Ong, Xin KerJustin RuiJRDepartment of Neurosurgery, National Neuroscience Institute, Singapore., Wai Hoe Ng, and Kai Rui Wan.
• Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
• Neuromodulation. 2023 Oct 1; 26 (7): 127612941276-1294.

ObjectiveThis study aimed to review the best evidence on the long-term efficacy of neurostimulation for chronic pain.Materials And MethodsWe 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.ResultsOf 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.ConclusionsNeurostimulation 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.Copyright © 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.

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