Spinal Cord Stimulation for Pain Management Following Spinal Cord Injury: A Systematic Review

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David M Gallacher,1 Michael Suarez,2 David S Jevotovsky,3 Whitman Oehlermarx,3 Tej D Azad,4 Ruben Dovlatyan,3 Harman Chopra,2 Mustafa Broachwala,5 Tariq AlFarra,6 Erika A Petersen,7 Kiran V Patel,8 Vwaire Orhurhu,9 Joel Castellanos10 1Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA; 2Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; 3Department of Physical Medicine and Rehabilitation, NYU Langone Health, New York, NY, USA; 4Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA; 5National Spine and Pain Centers, White Marsh, MD, USA; 6Department of Rehabilitation and Physical Medicine, Pain Management, Mount Sinai Health System, New York, NY, USA; 7Department of Neurosurgery, UAMS Health, Little Rock, AR, USA; 8Department of Anesthesiology, Pain Medicine, Northwell Health, New York, NY, USA; 9MVM Health, East Stroudsburg, PA, USA; 10Division of Pain Medicine, University of California - San Diego, La Jolla, CA, USACorrespondence: David M Gallacher, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA, Email dgallachermd@gmail.comPurpose: Chronic pain affects more than 80% of individuals with spinal cord injury (SCI), profoundly impairing mobility, rehabilitation, and quality of life. Conventional pharmacologic and non-pharmacologic treatments often fail to achieve adequate relief. Spinal cord stimulation (SCS) has emerged as a potential neuromodulatory therapy for neuropathic pain; however, its role in SCI remains insufficiently defined.Patients and methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered with PROSPERO (CRD42024541622). Comprehensive searches of PubMed, Embase, Web of Science, and the Cochrane Library were performed through April 2024. Eligible studies evaluated SCS for chronic pain in adults with SCI and reported validated pain or patient-reported outcomes. Screening, eligibility assessment, and data extraction were performed in duplicate. Risk of bias and certainty of evidence were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and the MethodologicAl STandards for Epidemiological Research (MASTER) tool.Results: From 1064 records, 10 studies involving 43 participants met inclusion criteria. Most were case reports or small case series, with one prospective cohort study. All studies reported pain improvement after SCS using heterogenous outcome formats; minor adverse events were reported in 3 studies, and the remaining 7 studies reported none. The overall certainty of evidence was rated very low due to small sample sizes, heterogeneity in study design, and methodological limitations. Three ongoing clinical trials evaluating SCS for pain in SCI were also identified.Conclusion: Preliminary, very low-certainty evidence indicates that SCS may be a promising option for chronic pain after SCI, with limited reported complications in the available literature. Higher-quality studies are required to confirm benefit, characterize risks, and guide patient selection and programming.Prospero Registration Number: CRD42024541622.Keywords: spinal cord stimulation, spinal cord injury, chronic pain, pain management

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