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We sought to assess the extent to which pain relief in chronic back and leg pain ( CBLP ) following spinal cord stimulation ( SCS ) is influenced by patient‐related factors, including pain location, and technology factors. A number of electronic databases were searched with citation searching of included papers and recent systematic reviews. All study designs were included. The primary outcome was pain relief following  SCS , we also sought pain score (pre‐ and post‐ SCS ). Multiple predictive factors were examined: location of pain, history of back surgery, initial level of pain, litigation/worker's compensation, age, gender, duration of pain, duration of follow‐up, publication year, continent of data collection, study design, quality score, method of  SCS  lead implant, and type of  SCS  lead. Between‐study association in predictive factors and pain relief were assessed by meta‐regression. Seventy‐four studies ( N  = 3,025 patients with  CBLP ) met the inclusion criteria; 63 reported data to allow inclusion in a quantitative analysis. Evidence of substantial statistical heterogeneity ( P  < 0.0001) in level of pain relief following  SCS  was noted. The mean level of pain relief across studies was 58% (95%  CI : 53% to 64%, random effects) at an average follow‐up of 24 months. Multivariable meta‐regression analysis showed no predictive patient or technology factors.  SCS  was effective in reducing pain irrespective of the location of  CBLP . This review supports  SCS  as an effective pain relieving treatment for  CBLP  with predominant leg pain with or without a prior history of back surgery. Randomized controlled trials need to confirm the effectiveness and cost‐effectiveness of  SCS  in the  CLBP  population with predominant low back pain.

pain practice

Predictors of Pain Relief Following Spinal Cord Stimulation in Chronic Back and Leg Pain and Failed Back Surgery Syndrome: A Systematic Review and Meta‐Regression Analysis