A Systematic Review of Gastrointestinal Changes Related to Spinal Cord Stimulation

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OBJECTIVES: Although spinal cord stimulation (SCS) is an established neuromodulatory therapy for chronic pain, its gastrointestinal (GI) effects beyond analgesia remain poorly characterized. This study synthesized the current evidence describing nonpain GI changes associated with permanent SCS implantation. MATERIALS AND METHODS: A systematic search of PubMed, Web of Science, and Scopus was conducted on April 25, 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Studies describing permanent SCS implantation with percutaneous or paddle leads in patients with baseline GI complaints and/or inducing GI changes were included. Animal models, reviews, and nonpermanent trial-only stimulations were excluded. The Oxford Centre for Evidence-Based Medicine hierarchy, study-design-specific methodologic quality assessments, and the Grading of Recommendations Assessment, Development, and Evaluation framework were used to assess study quality. Study characteristics, patient demographics, lead placement, stimulation paradigms, and GI outcomes were extracted. Nonpain GI effects were categorized as desired or undesired on the basis of the clinical direction of change relative to baseline. RESULTS: Overall, 21 studies comprising 143 patients were included, predominantly comprising case reports/series, along with two retrospective cohort studies, two prospective single-arm studies, and one randomized cross-over pilot trial. Most SCS implantations were performed for abdominal or visceral pain (88.8%). Thoracic lead placement was most common (69.2%), and 10-kHz stimulation was the predominant paradigm (46.2%). A total of 86 desired GI changes and 13 undesired GI changes were reported. The most frequent desired effects were decreased nausea (32.6%) and reduced diarrhea (12.8%), whereas worsened nausea (23.1%) was the most common adverse effect, followed by diarrhea (15.4%) and constipation (15.4%). CONCLUSIONS: GI changes have been identified with SCS use, most commonly improvements in nausea and bowel function, although adverse effects have been reported. Current evidence remains limited by heterogeneity and low certainty, highlighting the need for controlled studies with standardized GI outcome measures.

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