Effects of spinal cord stimulation on pain, physical activity, and self-efficacy among patients with neuropathic pain

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Effects of Spinal Cord Stimulation (SCS) on physical activity and self-efficacy remain unexplored. To evaluate effects of SCS on pain intensity, physical activity, health-related quality of life (HRQL), and self-efficacy among chronic neuropathic pain patients. Randomized controlled trial, the first phase of a 3-part intervention study. Patients >18 years of age underwent SCS implantation after a test trial and were randomized 1:1 to active SCS or conventional medical management (CMM) with the SCS switched off. Data were collected at baseline and 3 months after implantation regarding pain (Numeric Rating Scale; NRS), physical activity (accelerometer), HRQL, and self-efficacy. Participants implanted with SCS (n=42) were randomized to active SCS (n=21) or CMM (n=21). Nineteen participants crossed over from CMM to active SCS due to lack of pain relief. Neuropathic pain intensity decreased significantly from baseline to 3 months (NRS 6.7 to 4.5; p <0.001) in patients with active SCS. Moderate-to-vigorous physical activity increased by 26 minutes/week (87%), although not statistically significant. Patients reported significant improvements in HRQL and self-efficacy. SCS seems to reduce neuropathic pain intensity which might contribute to improvements in HRQL and self-efficacy. Low physical activity levels in this population should prompt targeted rehabilitation interventions. The https://clinicaltrials.gov/ identifier is NCT03740763 and the Västra Götaland Region (VGR) registry (https://www.researchweb.org/is/vgr/) identifier is 216271. Persistent nerve pain can be treated with Spinal Cord Stimulation (SCS) when usual pain management has failed. During this treatment, pain intensity is modified by electrical signals delivered to the spinal cord via an implanted electrode. In this study, we aimed to investigate whether SCS treatment could lower pain intensity and increase physical activity and self-efficacy among patients with persistent nerve pain. These patients usually have low physical activity levels. We implanted an SCS device in 42 patients and followed them for 3 months. After 3 months, patients reported considerably reduced pain intensity and improved quality of life. Physical activity levels were only slightly increased. Our results indicate that decreased pain intensity due to SCS might contribute to improved quality of life and self-efficacy. To further improve the low physical activity levels in patients with persistent nerve pain, the addition of tailored rehabilitation and exercise might be beneficial.

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