Effectiveness of Neuromodulation in Postoperative Pain Management Following Spine Surgery: A Systematic Review.

Postoperative analgesia following spinal surgical interventions continues to present a formidable challenge, particularly due to the high prevalence of lumbar spine surgeries and the inherent risks linked to opioid-based analgesic strategies. Neuromodulation has emerged as a promising therapeutic modality for the management of pain associated with these procedures. A systematic review was undertaken to identify randomized controlled trials (RCTs) that investigate the effectiveness of neuromodulation techniques in patients undergoing lumbar spinal surgeries for postoperative pain relief. A comprehensive search of online databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials investigating neuromodulation for postoperative pain relief following lumbar spinal surgery were included. Primary outcomes studied were opioid consumption and pain intensity scores. Through a systematic review, a limited selection of studies exploring neuromodulation techniques in patients undergoing lumbar spinal surgeries for postoperative pain relief was identified. Existing literature suggests potential benefits of transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) in reducing opioid consumption and alleviating postoperative pain. In individual randomized control trials within the review, TENS resulted in a 62% reduction in opioid use compared to sham, while motor/prefrontal tDCS had mixed results across trials. Findings from the studies suggest non-invasive neuromodulation techniques may potentially reduce postoperative opioid requirements after lumbar spine surgery. The smaller pool of available studies highlights a significant gap in research on neuromodulation for postoperative pain, especially for the lumbar surgery population. Further high-quality, large-scale randomized controlled trials are needed to investigate their functions within clinical practice.