{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T02:31:01Z","timestamp":1794018661809,"version":"4.8.0"},"reference-count":52,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Chronic back and lower extremity pain is one of the leading causes of disability worldwide. Spinal cord stimulation (SCS) aims to improve symptoms and quality of life.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the efficacy of SCS therapies compared with conventional medical management (CMM).<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n MEDLINE, Embase, and Cochrane Library were systematically searched from inception to September 2, 2022.<\/jats:p>\n <\/jats:sec>\n \n Study Selection<\/jats:title>\n Selected studies were randomized clinical trials comparing SCS therapies with sham (placebo) and\/or CMM or standard treatments for adults with chronic back or leg pain who had not previously used SCS.<\/jats:p>\n <\/jats:sec>\n \n Data Extraction and Synthesis<\/jats:title>\n Evidence synthesis estimated odds ratios (ORs) and mean differences (MDs) and their associated credible intervals (CrI) through bayesian network meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for network meta-analyses was followed.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were pain-related end points, including pain intensity (measured by visual analog scale) and proportion of patients achieving at least 50% pain relief (responder rate) in the back or leg. Quality of life (measured by EQ-5D index score) and functional disability (measured by the Oswestry Disability Index score) were also considered.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 13 studies of 1561 patients were included in the network meta-analysis comparing conventional and novel SCS therapies with CMM across the 6 outcomes of interest at the 6-month follow-up. Both conventional and novel SCS therapies were associated with superior efficacy compared with CMM in responder rates in back (conventional SCS: OR, 3.00; 95% CrI, 1.49 to 6.72; novel SCS: OR, 8.76; 95% CrI, 3.84 to 22.31), pain intensity in back (conventional SCS: MD, \u22121.17; 95% CrI, \u22121.64 to \u22120.70; novel SCS: MD, \u22122.34; 95% CrI, \u22122.96 to \u22121.73), pain intensity in leg (conventional SCS: MD, \u22122.89; 95% CrI, \u22124.03 to \u22121.81; novel SCS: MD, \u22124.01; 95% CrI, \u22125.31 to \u22122.75), and EQ-5D index score (conventional SCS: MD, 0.15; 95% CrI, 0.09 to 0.21; novel SCS: MD, 0.17; 95% CrI, 0.13 to 0.21). For functional disability, conventional SCS was superior to CMM (MD, \u22127.10; 95% CrI, \u221210.91 to \u22123.36). No statistically significant differences were observed for other comparisons.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This systematic review and network meta-analysis found that SCS therapies for treatment of chronic pain in back and\/or lower extremities were associated with greater improvements in pain compared with CMM. These findings highlight the potential of SCS therapies as an effective and valuable option in chronic pain management.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.44608","type":"journal-article","created":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T11:00:53Z","timestamp":1731582053000},"page":"e2444608","source":"Crossref","is-referenced-by-count":54,"title":["Spinal Cord Stimulation vs Medical Management for Chronic Back and Leg Pain"],"prefix":"10.1001","volume":"7","author":[{"given":"Frank J. P. M.","family":"Huygen","sequence":"first","affiliation":[{"name":"Erasmus Medical Center, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Soulanis","sequence":"additional","affiliation":[{"name":"IQVIA, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ketevan","family":"Rtveladze","sequence":"additional","affiliation":[{"name":"IQVIA, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheily","family":"Kamra","sequence":"additional","affiliation":[{"name":"IQVIA, Gurugram, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Schlueter","sequence":"additional","affiliation":[{"name":"IQVIA, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,11,14]]},"reference":[{"key":"zoi241276r1","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1186\/1471-2458-13-1229","article-title":"The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care.","volume":"13","author":"Breivik","year":"2013","journal-title":"BMC Public Health"},{"issue":"36","key":"zoi241276r2","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.15585\/mmwr.mm6736a2","article-title":"Prevalence of chronic pain and high-impact chronic pain among adults\u2014United States, 2016.","volume":"67","author":"Dahlhamer","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"9","key":"zoi241276r3","doi-asserted-by":"publisher","first-page":"1740","DOI":"10.1097\/j.pain.0000000000002557","article-title":"A global study of pain prevalence across 52 countries: examining the role of country-level contextual factors.","volume":"163","author":"Zimmer","year":"2022","journal-title":"Pain"},{"issue":"12","key":"zoi241276r4","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013756.pub2","article-title":"Implanted spinal neuromodulation interventions for chronic pain in adults.","volume":"12","author":"O\u2019Connell","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"zoi241276r5","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD014789.pub2","article-title":"Spinal cord stimulation for low back pain.","volume":"3","author":"Traeger","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"issue":"8","key":"zoi241276r6","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1093\/pm\/pnad047","article-title":"Striking errors in the methodology, execution, and conclusions of the Cochrane Library review of spinal cord stimulation for low back pain by Traeger et al.","volume":"24","author":"Durbhakula","year":"2023","journal-title":"Pain Med"},{"issue":"5","key":"zoi241276r7","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1016\/j.neurom.2023.03.005","article-title":"Problems with O\u2019Connell et al, \u201cImplanted Spinal Neuromodulation Interventions for Chronic Pain in Adults\u201d (Cochrane Review).","volume":"26","author":"Russo","year":"2023","journal-title":"Neuromodulation"},{"issue":"6","key":"zoi241276r8","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.medcli.2016.02.025","article-title":"The PRISMA Statement Extension for Systematic Reviews Incorporating Network Meta-Analysis: PRISMA-NMA.","volume":"147","author":"Hutton","year":"2016","journal-title":"Med Clin (Barc)"},{"issue":"1","key":"zoi241276r11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v076.i01","article-title":"Stan: a probabilistic programming language.","volume":"76","author":"Carpenter","year":"2017","journal-title":"J Stat Softw"},{"key":"zoi241276r13","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1002\/jae.1278","article-title":"RStudio: a platform-independent IDE for R and Sweave.","volume":"27","author":"Racine","year":"2012","journal-title":"J Appl Econ"},{"issue":"6","key":"zoi241276r16","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1002\/sim.6381","article-title":"Predictive distributions for between-study heterogeneity and simple methods for their application in Bayesian meta-analysis.","volume":"34","author":"Turner","year":"2015","journal-title":"Stat Med"},{"issue":"4","key":"zoi241276r17","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1111\/1467-9868.00353","article-title":"Bayesian measures of model complexity and fit.","volume":"64","author":"Spiegelhalter","year":"2002","journal-title":"J R Stat Soc B"},{"issue":"8","key":"zoi241276r18","doi-asserted-by":"publisher","first-page":"538","DOI":"10.7326\/M18-3542","article-title":"Threshold analysis as an alternative to GRADE for assessing confidence in guideline recommendations based on network meta-analyses.","volume":"170","author":"Phillippo","year":"2019","journal-title":"Ann Intern Med"},{"issue":"1-2","key":"zoi241276r19","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.pain.2007.07.028","article-title":"Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome.","volume":"132","author":"Kumar","year":"2007","journal-title":"Pain"},{"issue":"6","key":"zoi241276r20","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1001\/jamaneurol.2021.0538","article-title":"Effect of high-frequency (10-kHz) spinal cord stimulation in patients with painful diabetic neuropathy: a randomized clinical trial.","volume":"78","author":"Petersen","year":"2021","journal-title":"JAMA Neurol"},{"issue":"11","key":"zoi241276r21","doi-asserted-by":"publisher","first-page":"2426","DOI":"10.1016\/j.pain.2014.08.031","article-title":"Spinal cord stimulation in patients with painful diabetic neuropathy: a multicentre randomized clinical trial.","volume":"155","author":"de Vos","year":"2014","journal-title":"Pain"},{"issue":"6","key":"zoi241276r22","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.1097\/j.pain.0000000000001510","article-title":"Multicolumn spinal cord stimulation for predominant back pain in failed back surgery syndrome patients: a multicenter randomized controlled trial.","volume":"160","author":"Rigoard","year":"2019","journal-title":"Pain"},{"issue":"11","key":"zoi241276r23","doi-asserted-by":"publisher","first-page":"3016","DOI":"10.2337\/dc14-0684","article-title":"Spinal cord stimulation and pain relief in painful diabetic peripheral neuropathy: a prospective two-center randomized controlled trial.","volume":"37","author":"Slangen","year":"2014","journal-title":"Diabetes Care"},{"issue":"2","key":"zoi241276r24","doi-asserted-by":"publisher","first-page":"188","DOI":"10.3171\/2021.12.SPINE211301","article-title":"Treatment of nonsurgical refractory back pain with high-frequency spinal cord stimulation at 10 kHz: 12-month results of a pragmatic, multicenter, randomized controlled trial.","volume":"37","author":"Kapural","year":"2022","journal-title":"J Neurosurg Spine"},{"issue":"12","key":"zoi241276r25","doi-asserted-by":"publisher","first-page":"2401","DOI":"10.1093\/pm\/pnx241","article-title":"Prospective, randomized blind effect-on-outcome study of conventional vs high-frequency spinal cord stimulation in patients with pain and disability due to failed back surgery syndrome.","volume":"18","author":"De Andres","year":"2017","journal-title":"Pain Med"},{"issue":"10","key":"zoi241276r26","doi-asserted-by":"publisher","first-page":"1971","DOI":"10.1093\/pm\/pnz019","article-title":"Wireless high-frequency spinal cord stimulation (10 kHz) compared with multiwaveform low-frequency spinal cord stimulation in the management of chronic pain in failed back surgery syndrome subjects: preliminary results of a multicenter, prospective randomized controlled study.","volume":"20","author":"Bolash","year":"2019","journal-title":"Pain Med"},{"issue":"2","key":"zoi241276r28","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/S1474-4422(19)30414-4","article-title":"Long-term safety and efficacy of closed-loop spinal cord stimulation to treat chronic back and leg pain (Evoke): a double-blind, randomised, controlled trial.","volume":"19","author":"Mekhail","year":"2020","journal-title":"Lancet Neurol"},{"issue":"4","key":"zoi241276r29","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1097\/ALN.0000000000000774","article-title":"Novel 10-kHz high-frequency therapy (HF10 therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: the SENZA-RCT randomized controlled trial.","volume":"123","author":"Kapural","year":"2015","journal-title":"Anesthesiology"},{"issue":"8","key":"zoi241276r30","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1111\/papr.13066","article-title":"Twelve-month results from multicenter, open-label, randomized controlled clinical trial comparing differential target multiplexed spinal cord stimulation and traditional spinal cord stimulation in subjects with chronic intractable back pain and leg pain.","volume":"21","author":"Fishman","year":"2021","journal-title":"Pain Pract"},{"issue":"3","key":"zoi241276r31","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1111\/ner.13090","article-title":"Potential therapeutic effect of low amplitude burst spinal cord stimulation on pain.","volume":"24","author":"Leong","year":"2021","journal-title":"Neuromodulation"},{"issue":"9","key":"zoi241276r32","doi-asserted-by":"publisher","first-page":"2810","DOI":"10.3390\/jcm9092810","article-title":"Sub-perception and supra-perception spinal cord stimulation in chronic pain syndrome: a randomized, semi-double-blind, crossover, placebo-controlled trial.","volume":"9","author":"Sokal","year":"2020","journal-title":"J Clin Med"},{"issue":"5","key":"zoi241276r33","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1111\/ner.12771","article-title":"Prospective, randomized, sham-control, double blind, crossover trial of subthreshold spinal cord stimulation at various kilohertz frequencies in subjects suffering from failed back surgery syndrome (SCS frequency study).","volume":"21","author":"Al-Kaisy","year":"2018","journal-title":"Neuromodulation"},{"issue":"9","key":"zoi241276r34","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1056\/NEJM200008313430904","article-title":"Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy.","volume":"343","author":"Kemler","year":"2000","journal-title":"N Engl J Med"},{"issue":"1","key":"zoi241276r35","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1111\/ner.13251","article-title":"How should we use multicolumn spinal cord stimulation to optimize back pain spatial neural targeting: a prospective, multicenter, randomized, double-blind, controlled trial (ESTIMET study).","volume":"24","author":"Rigoard","year":"2021","journal-title":"Neuromodulation"},{"issue":"15","key":"zoi241276r36","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1001\/jama.2022.18231","article-title":"Effect of spinal cord burst stimulation vs placebo stimulation on disability in patients with chronic radicular pain after lumbar spine surgery: a randomized clinical trial.","volume":"328","author":"Hara","year":"2022","journal-title":"JAMA"},{"issue":"5","key":"zoi241276r37","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1227\/01.NEU.0000180030.00167.b9","article-title":"Spinal cord stimulation electrode design: a prospective, randomized, controlled trial comparing percutaneous with laminectomy electrodes: part II-clinical outcomes.","volume":"57","author":"North","year":"2005","journal-title":"Neurosurgery"},{"issue":"2","key":"zoi241276r38","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1007\/s40122-021-00268-7","article-title":"A comparison of 1000 Hz to 30 Hz spinal cord stimulation strategies in patients with unilateral neuropathic leg pain due to failed back surgery syndrome: a multicenter, randomized, double-blinded, crossover clinical study (HALO).","volume":"10","author":"Breel","year":"2021","journal-title":"Pain Ther"},{"issue":"1","key":"zoi241276r39","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1111\/ner.13467","article-title":"Comparison of paresthesia mapping with anatomic placement in burst spinal cord stimulation: long-term results of the prospective, multicenter, randomized, double-blind, crossover CRISP study.","volume":"25","author":"Al-Kaisy","year":"2022","journal-title":"Neuromodulation"},{"issue":"4","key":"zoi241276r40","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1097\/j.pain.0000000000000814","article-title":"Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial.","volume":"158","author":"Deer","year":"2017","journal-title":"Pain"},{"issue":"3","key":"zoi241276r41","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1016\/j.neurom.2021.11.010","article-title":"Spinal cord stimulation with additional peripheral nerve\/field stimulation versus spinal cord stimulation alone on back pain and quality of life in patients with persistent spinal pain syndrome.","volume":"26","author":"van Heteren","year":"2023","journal-title":"Neuromodulation"},{"issue":"8","key":"zoi241276r42","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1016\/j.neurom.2022.10.009","article-title":"Two-year outcomes using an SCS system capable of combination therapy: a randomized controlled trial (COMBO).","volume":"25","author":"Wallace","year":"2022","journal-title":"Neuromodulation"},{"issue":"1","key":"zoi241276r46","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1111\/ner.13019","article-title":"Anatomic lead placement without paresthesia mapping provides effective and predictable therapy during the trial evaluation period: results from the prospective, multicenter, randomized, DELIVERY study.","volume":"23","author":"Pope","year":"2020","journal-title":"Neuromodulation"},{"issue":"12","key":"zoi241276r47","doi-asserted-by":"publisher","first-page":"2820","DOI":"10.1097\/j.pain.0000000000001977","article-title":"Does a screening trial for spinal cord stimulation in patients with chronic pain of neuropathic origin have clinical utility and cost-effectiveness (TRIAL-STIM): a randomised controlled trial.","volume":"161","author":"Eldabe","year":"2020","journal-title":"Pain"},{"issue":"1","key":"zoi241276r48","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1111\/ner.12746","article-title":"Effects of rate on analgesia in kilohertz frequency spinal cord stimulation: results of the PROCO randomized controlled trial.","volume":"21","author":"Thomson","year":"2018","journal-title":"Neuromodulation"},{"issue":"1","key":"zoi241276r49","first-page":"1","article-title":"Sensor-driven position-adaptive spinal cord stimulation for chronic pain.","volume":"15","author":"Schultz","year":"2012","journal-title":"Pain Physician"},{"key":"zoi241276r50","doi-asserted-by":"publisher","first-page":"379","DOI":"10.25259\/SNI_1032_2021","article-title":"Randomized controlled trials in neurosurgery.","volume":"13","author":"Takroni","year":"2022","journal-title":"Surg Neurol Int"},{"issue":"1","key":"zoi241276r51","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1097\/BRS.0b013e31815e3a10","article-title":"Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change.","volume":"33","author":"Ostelo","year":"2008","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"zoi241276r52","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1007\/s11136-004-7713-0","article-title":"Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D.","volume":"14","author":"Walters","year":"2005","journal-title":"Qual Life Res"},{"key":"zoi241276r9","doi-asserted-by":"crossref","DOI":"10.1002\/9781119536604","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins","year":"2019","edition":"2nd ed"},{"key":"zoi241276r14","author":"Phillippo","year":"2021"},{"key":"zoi241276r15","volume-title":"NICE DSU Technical Support Document 2: A Generalised Linear Modelling Framework for Pairwise and Network Meta-Analysis of Randomised Controlled Trials","author":"Dias","year":"2014"},{"key":"zoi241276r27","author":"Al-Kaisy","year":"2021"},{"key":"zoi241276r10","unstructured":"Cochrane. RoB 2: a revised Cochrane risk-of-bias tool for randomized trials. Accessed October 10, 2024. https:\/\/methods.cochrane.org\/bias\/resources\/rob-2-revised-cochrane-risk-bias-tool-randomized-trials"},{"key":"zoi241276r12","unstructured":"R Project for Statistical Computing. R: A language and environment for statistical computing. http:\/\/www.R-project.org\/2016"},{"key":"zoi241276r43","unstructured":"ClinicalTrials.gov. Safety and effectiveness study of the precision SCS systems adapted for high-rate spinal cord stimulation (ACCELERATE). Accessed October 10, 2024. https:\/\/clinicaltrials.gov\/study\/NCT02093793"},{"key":"zoi241276r44","unstructured":"ClinicalTrials.gov. Evaluation of conventional and long pulse widths during a temporary spinal cord stimulation trial Accessed October 10, 2024. https:\/\/clinicaltrials.gov\/study\/NCT03526055"},{"key":"zoi241276r45","unstructured":"ClinicalTrials.gov. Spinal cord stimulation in patients with post-laminectomy syndrome in testing phase. Accessed October 10, 2024. https:\/\/clinicaltrials.gov\/study\/NCT03702010"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2826172\/huygen_2024_oi_241276_1730921788.0471.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T11:00:57Z","timestamp":1731582057000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2826172"}},"subtitle":["A Systematic Review and Network Meta-Analysis"],"short-title":[],"issued":{"date-parts":[[2024,11,14]]},"references-count":52,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,11,4]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.44608","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,14]]}}}