Spinal cord stimulation for cancer pain: a narrative review of mechanistic rationale, clinical integration, and emerging applications.

Abstract

Background and objective: Pain remains one of the most prevalent symptoms among patients with advanced cancer, with a substantial subset experiencing persistent pain despite optimized pharmacologic management. Although spinal cord stimulation (SCS) has emerged as a potential neuromodulatory option for refractory cancer-related pain, its role within contemporary multidisciplinary cancer pain management remains incompletely defined. This narrative review examines the mechanistic rationale, clinical applications, guideline positioning, and practical implementation of SCS across cancer pain phenotypes.

Methods: A narrative literature search was conducted using PubMed/MEDLINE, Cochrane Library, Embase, ClinicalTrials.gov, and relevant guideline sources from database inception through May 21, 2026. Search terms included combinations of "spinal cord stimulation", "SCS", "neuromodulation", "cancer pain", "cancer-related pain", "refractory cancer pain", "palliative care", "chemotherapy-induced peripheral neuropathy", "CIPN", "intrathecal drug delivery", "dorsal root ganglion stimulation", and "peripheral nerve stimulation". English-language clinical studies (prospective and retrospective), case reports, case series, systematic, scoping, and narrative reviews, guideline statements, and relevant preclinical studies were considered.

Key content and findings: Available evidence, consisting predominantly of retrospective cohorts and case-based literature without randomized trials, suggests that SCS may provide clinically meaningful pain relief and opioid-sparing benefit in selected patients with refractory cancer pain. This review contextualizes SCS within contemporary cancer pain management by examining its mechanistic foundations, waveform evolution, patient selection, prognosis-sensitive decision-making, magnetic resonance imaging (MRI) compatibility, and comparative positioning relative to intrathecal drug delivery systems and other interventional therapies. Emerging applications, particularly in chemotherapy-induced neuropathy and survivorship-related pain syndromes, are also discussed.

Conclusions: SCS represents a promising yet selectively applicable modality for refractory cancer-related pain, particularly among patients with neuropathic and mixed pain phenotypes inadequately controlled with pharmacotherapy alone. Rather than functioning as a competing alternative to existing cancer pain interventions, SCS should be considered within a broader, multidisciplinary, phenotype-informed framework that includes guideline-directed pharmacologic care, interventional procedures, and neuromodulatory strategies such as intrathecal drug delivery. Future prospective studies are needed not only to clarify efficacy but also to refine patient selection and optimize the integration of SCS into modern cancer pain care.