A meta-analysis of modern neuro-stimulation modalities-Advances in neuro-stimulation techniques.

Background: Chronic pain is a debilitating condition that affects about 3% of the population globally. Conventionally, pharmacologic approaches, psychotherapy, and surgery have been used in the management of chronic refractory pain. However, over the past decades, advances in neurotechnology have enabled modern novel techniques of neurostimulation, such as spinal cord stimulation (SCS) and dorsal root ganglion (DRG), to be used in the management of chronic neuropathic pain that does not respond to conventional management. This review, therefore, aims to establish the efficacy of these two novel technologies in the management of chronic neuropathic pain compared to conventional medical management (CMM) techniques.

Methods: A systematic search was conducted on three electronic databases, PubMed, Science Direct, and CENTRAL, for all relevant articles to the study topic. After a detailed review by two independent reviewers, only the articles that met the inclusion criteria were included. The Review Manager 5.4 software was utilized to conduct a meta-analysis of the outcomes of pain reduction.

Results: Our online search yielded 345 articles; however, only eight studies were included in the analysis according to our inclusion criteria. The results from our pooled analysis indicated that SCS and dorsal root stimulation both resulted in a significant reduction in the rating of chronic pain mean difference (MD) (-4.73; 95% confidence interval [CI] [-4.76, -4.71] P < 0.00001) and MD (-1.09; 95% CI [-1.29, -0.90] P < 0.00001), respectively. Similarly, for the studies that reported percentage change in pain rating, the pooled analysis showed that SCS resulted in a higher percentage reduction in pain rating compared to CMM MD (69.47; 95% CI [64.31, 74.64] P < 0.00001).

Conclusion: Based on the results of our analysis, we conclude that advances in neurostimulation techniques, such as SCS and DRG stimulation, have resulted in better management of chronic neuropathic pain compared to conventional pain management techniques.