Background Chronic intractable pain from peripheral neuropathy is a debilitating condition that might not respond to conventional medical management and pharmacotherapy. The primary objective of this systematic review was to assess change (or reduction) in pain intensity in patients with length-dependent peripheral neuropathy after spinal cord stimulation (SCS) therapy. Methods This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The primary outcome was change (or reduction) in pain intensity after 12 months of SCS therapy compared with baseline in participants with length-dependent peripheral neuropathy. Secondary outcomes included change in pain intensity after 6 months and change in opioid consumption after 12 months. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to appraise the quality of evidence. Results Nineteen studies consisting of 376 participants who underwent SCS implantation met the inclusion criteria. Qualitative synthesis revealed that all eligible studies reported a significant improvement in pain intensity after 12 months of SCS therapy as compared with baseline. Mean differences with 95% confidence intervals were calculated for 4 studies, all of which achieved the minimal clinically important difference for change in pain intensity at 12 months. The GRADE quality of evidence for this outcome was appraised as very low quality. Conclusion This systematic review highlights that SCS could lead to significant improvement in pain intensity for length-dependent peripheral neuropathy, although future well-powered randomized controlled trials are warranted to increase the certainty of evidence in this finding. Study registration PROSPERO (https://www.crd.york.ac.uk/PROSPERO/) ID: CRD42022377572.

中文翻译：

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使用脊髓刺激治疗长度依赖性周围神经病的疼痛：系统评价

背景 周围神经病变引起的慢性顽固性疼痛是一种使人衰弱的疾病，传统的医疗管理和药物治疗可能不会产生反应。本系统评价的主要目的是评估脊髓刺激（SCS）治疗后长度依赖性周围神经病变患者疼痛强度的变化（或减轻）。方法 本系统评价遵循系统评价和荟萃分析的首选报告项目 (PRISMA) 指南。主要结局是患有长度依赖性周围神经病的参与者在接受 12 个月的 SCS 治疗后，与基线相比疼痛强度发生变化（或减轻）。次要结局包括 6 个月后疼痛强度的变化和 12 个月后阿片类药物消耗量的变化。建议评估、制定和评估分级 (GRADE) 指南用于评估证据的质量。结果 19 项研究由 376 名接受 SCS 植入的参与者组成，符合纳入标准。定性综合显示，所有符合条件的研究均报告，与基线相比，12 个月的 SCS 治疗后疼痛强度显着改善。计算了 4 项研究的平均差异（95% 置信区间），所有研究均在 12 个月时实现了疼痛强度变化的最小临床重要差异。该结果的证据 GRADE 质量被评价为非常低质量。结论 本系统综述强调，SCS 可以显着改善长度依赖性周围神经病的疼痛强度，尽管未来有必要进行强有力的随机对照试验来提高这一发现的证据的确定性。研究注册 PROSPERO (https://www.crd.york.ac.uk/PROSPERO/) ID：CRD42022377572。