Comparative Efficacy of Spinal Cord Stimulation in the Management of Acute Pain and Chronic Pain Related to Failed Back Surgery Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Spinal cord stimulation (SCS) is a well-established treatment for chronic pain. However, its potential in acute pain management requires further investigation. The goal of this review is to assess and compare the effectiveness of SCS for managing acute postoperative pain against chronic pain associated with failed back surgery syndrome (FBSS). A comprehensive search of databases identified randomized controlled trials (RCTs) that examined SCS for both acute and chronic pain associated with FBSS. Pain relief was measured using the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS). Study quality was evaluated using the Jadad score and Cochrane risk of bias tool. Evidence suggests that SCS significantly reduces acute pain, achieving over a 50% reduction in VAS scores. For chronic pain associated with FBSS, SCS demonstrated substantial efficacy, with a mean reduction of -2.45 on pain scales compared to baseline. When compared to optimal medical management (OMM), SCS was more effective, showing a mean reduction of -1.17 in pain scores for FBSS. Overall, SCS offers significant benefits in managing chronic pain, particularly in FBSS, by reducing pain intensity and opioid use. While the initial findings for acute pain relief are promising, further high-quality RCTs are needed to better understand SCS's role in preventing the transition from acute to chronic pain. Continued research into optimizing patient selection and stimulation parameters will be essential to improve therapeutic outcomes in both acute and chronic pain management.