Al-Ghanim Hassan A, Aleid Zainab M, Aldanyowi Saud N, Aleid Abdulsalam M
Department of Surgery, College of Medicine, King Faisal University, Al-Hofuf, Saudi Arabia.
Surg Neurol Int. 2025 Apr 18;16:137. doi: 10.25259/SNI_521_2024. eCollection 2025.
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.
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.
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.
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.
与骨骼问题相关的慢性疼痛的管理一直通过使用神经刺激方法来实现，如脊髓刺激（SCS）和外周神经刺激（PNS）。然而，它们相比之下的成功程度仍不清楚。本综述和荟萃分析评估了SCS和PNS在减轻与骨骼异常相关的慢性疼痛患者的慢性疼痛和改善功能结果方面的有效性。
为了找到比较SCS或PNS与标准药物治疗或安慰剂/假治疗在患有与骨骼疾病相关的慢性疼痛的成人中的随机对照试验（RCT），从数据库开始到2024年2月，对PubMed、MEDLINE、Embase、CINAHL、Cochrane对照试验中央注册库和ClinicalTrials.gov进行了全面检索。主要结果是无疼痛。阿片类药物使用、功能状态和生活质量是次要结果。采用Cochrane方法评估偏倚风险。使用随机效应荟萃分析计算95%置信区间（CI）的风险比（RR）或标准化均差（SMD）。
我们纳入了20项RCT，共2576名参与者。在短期（≤6个月）随访中，SCS和PNS与比传统医疗护理或安慰剂/假治疗显著更高的疼痛缓解相关：SCS的SMD为-0.87（95%CI -1.19--0.55），PNS的SMD为-0.56（95%CI -0.91-0.21）。在长期（>6个月）随访中，SCS的SMD为-0.71（95%CI -1.05--0.37）和PNS的SMD为-0.60（95%CI -1.03--0.17）的益处得以维持。SCS和PNS还显著改善了身体和情感功能以及生活质量。结果显示SCS（RR 0.57，95%CI 0.44-0.74）和PNS（RR 0.58，95%CI 0.43-0.77）降低了阿片类药物使用风险。
在改善功能和生活质量方面，SCS和PNS都能暂时和永久地减轻与骨骼问题相关的慢性疼痛。在一些个体中，SCS和PNS可能有助于降低阿片类药物的消费量。神经刺激治疗可能对治疗与骨骼疾病相关的持续性疼痛有用。
