Return to Work of Patients Treated With Spinal Cord Stimulation for Chronic Pain: A Systematic Review and Meta-Analysis

Background: Chronic pain has a substantial negative impact on work-related outcomes, which underscores the importance of interventions to reduce the burden. Spinal cord stimulation (SCS) efficiently causes pain relief in specific chronic pain syndromes. The aim of this review was to identify and summarize evidence on returning to work in patients with chronic pain treated with SCS.

Materials and methods: A systematic literature review was performed including studies from PubMed, EMBASE, SCOPUS, and Web of Science (up till October 2017). Risk of bias was assessed using a modified version of the Downs & Black checklist. Where possible, we pooled data using random effects meta-analysis. The study protocol was registered prior to initiation of the review process (PROSPERO CRD42017077803).

Results: Fifteen full-text articles (total articles screened: 2835) were included. Risk of bias for these articles was scored low. Seven trials provided sufficient data and were judged similar enough to be pooled for meta-analysis on binary outcomes. SCS intervention results in a higher prevalence of patients at work compared with before treatment (odds ratio [OR] 2.15; 95% confidence interval [CI], 1.44-3.21; I² = 42%; p < 0.001). SCS treatment also results in high odds to return to work (OR 29.06; 95% CI, 9.73-86.75; I² = 0%; p < 0.001).

Conclusions: Based on available literature, SCS proved to be an effective approach to stimulate return to work in patients with specific chronic pain syndromes.