The following is a summary of “Systematic review and meta-analysis of conventional medical management in a patient population with refractory chronic pain suitable to receive a spinal cord stimulation system,” published in the February 2025 issue of Pain by Russo et al. 

Researchers conducted a retrospective study to systematically identify evidence comparing conventional medical management (CMM) in randomized controlled trials (RCTs) of spinal cord stimulation (SCS) therapy and assess whether continued CMM provided significant pain relief and if its effects improved over time.  

They searched databases from inception to June 2024 for RCTs comparing SCS to CMM. The primary outcome was the absolute change in pain intensity from baseline to the last follow-up in the CMM group, measured using a visual analogue scale or numerical rating scale. The treatment effect was assessed using mean difference (MD) and 95% confidence interval (CI) for absolute and percentage changes in pain intensity. The risk of bias (RoB) was evaluated using the revised Cochrane RoB tool. The review protocol was registered on PROSPERO (CRD42023449215).  

The results showed that CMM was not associated with significant reductions in pain intensity at the last follow-up (MD -0.11; 95% CI: -0.32 to 0.11; moderate certainty). Similarly, there was no change in pain intensity percentage (MD -3.22%; 95% CI: -12.59% to 6.14%; moderate certainty). No significant differences were found by decade of publication for absolute (P = 0.065; moderate certainty) or percent change in pain intensity (P = 0.524; moderate certainty). The 6-month follow-up meta-analysis and sensitivity analysis showed similar numerical results.  

Investigators concluded that CMM for patients eligible for SCS did not provide substantial pain relief and remained largely unchanged over recent decades, suggesting a need to reassess its use as a control in SCS treatment evaluations. 

Source: academic.oup.com/painmedicine/advance-article-abstract/doi/10.1093/pm/pnaf004/7997276