The efficacy of neurostimulation techniques for the management of chronic pain associated with bone disorders: A systematic review and meta-analysis

Background The management of chronic pain associated with bone problems has been accomplished by the use of neurostimulation methods, such as spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS). It is still unknown, however, how successful they are in comparison. The effectiveness of SCS and PNS in reducing chronic pain and enhancing functional results in patients with chronic pain related to bone abnormalities was assessed in this comprehensive review and meta-analysis. Methods To find randomized controlled trials (RCTs) comparing SCS or PNS to standard medical management or placebo/sham treatment in adults with chronic pain related to bone disorders, a comprehensive search of PubMed, MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov was carried out from the start of the database until February 2024. The main result was the absence of discomfort. Opioid usage, functional status, and quality of life were secondary outcomes. The Cochrane technique was used to evaluate bias risk. The risk ratios (RRs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were computed using random effects meta-analysis. Results We included 20 RCTs with a total of 2576 participants. In short-term (≤6 months) follow-up, SCS and PNS were both associated with substantially higher pain alleviation than conventional medical care or placebo/sham: SCS SMD −0.87 (95% CI −1.19–−0.55), PNS SMD −0.56 (95% CI −0.91–0.21). SCS SMD −0.71 (95% CI −1.05–−0.37) and PNS SMD −0.60 (95% CI −1.03–−0.17) benefits were maintained at long-term (>6 months) follow-up. The physical and emotional functioning, as well as quality of life, were also markedly enhanced by SCS and PNS. It was shown that SCS (RR 0.57, 95% CI 0.44–0.74) and PNS (RR 0.58, 95% CI 0.43–0.77) reduced the risk of opioid usage. Conclusion When it comes to improving functionality and quality of life, SCS and PNS both reduce chronic pain linked to bone problems, both temporarily and permanently. In some individuals, SCS and PNS may assist in lowering opioid consumption. Neurostimulation treatments may be useful in the treatment of persistent pain associated with bone diseases.