Patient Satisfaction With Spinal Cord Stimulation and Dorsal Root Ganglion Stimulation for Chronic Intractable Pain: A Systematic Review and Meta-Analysis



      In the spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRG-S) literature, the typical primary outcome measure includes pain relief, whether numeric rating scale changes or percentage pain relief, and functional outcomes and patient satisfaction are included as secondary outcomes. This systematic review and meta-analysis aims to determine the rate of patient satisfaction with the use of SCS and DRG-S in the treatment of chronic intractable pain.

      Materials and Methods

      The study protocol was registered in the PROSPERO International prospective register of systematic reviews. We queried articles from multiple electronic data bases, including MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials data bases, and hand-searched reference lists of identified publications. All periods were included. Inclusion criteria encompassed randomized controlled trials (RCTs) and prospective observational studies that reported patient satisfaction in patients who underwent SCS or DRG-S. Bias evaluation for the included studies involved appropriate guidelines for each study design (Cochrane risk of bias tool for RCTs and Newcastle-Ottawa scale for observational studies).


      Our search strategy identified 242 unique citations, of which nine RCTs and 23 observational studies were included for analysis. Overall, 25 studies comprising 1355 participants were pooled in our quantitative analysis. The pooled proportion of patients who reported satisfaction from all studies was 82.2% (95% CI, 77.8%–86.2%). This finding had high statistical heterogeneity (I2 = 74.0%). Subgroup analysis did not reveal differences in satisfaction when studies were stratified based on study design (RCT or observational study) or follow-up period (six, 12, 24, and 36 months).


      Our results show high levels of patient satisfaction across the SCS and DRG-S literature when these treatment modalities are used for chronic intractable pain, regardless of SCS programming algorithm. However, there is a scarcity of unbiased and/or non–industry-funded prospective studies in the neuromodulation field, and future efforts to expand this area of the SCS and DRG-S literature are greatly needed.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hagedorn J.M.
        • Deer T.R.
        • Canzanello N.C.
        • et al.
        Differences in calculated percentage improvement versus patient-reported percentage improvement in pain scores: a review of spinal cord stimulation trials.
        Reg Anesth Pain Med. 2021; 46: 293-297
        • Page M.J.
        • Shamseer L.
        • Tricco A.C.
        Registration of systematic reviews in PROSPERO: 30,000 records and counting.
        Syst Rev. 2018; 7: 32
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        J Clin Epidemiol. 2009; 62: e1-e34
        • Higgins J.P.
        • Altman D.G.
        • Gøtzsche P.C.
        • et al.
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Wells G.A.
        • Shea B.
        • O’Connell D.
        • et al.
        The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses.
        The Ottawa Hospital Research Institute, 2013: 1-4
        • DerSimonian R.
        • Laird N.
        Meta-analysis in clinical trials.
        Control Clin Trials. 1986; 7: 177-188
        • Freeman M.F.
        • Tukey J.W.
        Transformations related to the angular and the square root.
        Ann Math Statist. 1950; 21: 607-611
        • Deer T.R.
        • Levy R.M.
        • Kramer J.
        • et al.
        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.
        Pain. 2017; 158: 669-681
        • Deer T.
        • Slavin K.V.
        • Amirdelfan K.
        • et al.
        Success using neuromodulation with BURST (SUNBURST) study: results from a prospective, randomized controlled trial using a novel burst waveform.
        Neuromodulation. 2018; 21: 56-66
        • de Vos C.C.
        • Meier K.
        • Zaalberg P.B.
        • et al.
        Spinal cord stimulation in patients with painful diabetic neuropathy: a multicentre randomized clinical trial.
        Pain. 2014; 155: 2426-2431
        • Kapural L.
        • Yu C.
        • Doust M.W.
        • et al.
        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.
        Anesthesiology. 2015; 123: 851-860
        • Kapural L.
        • Yu C.
        • Doust M.W.
        • et al.
        Comparison of 10-kHz high-frequency and traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: 24-month results from a multicenter, randomized, controlled pivotal trial.
        Neurosurgery. 2016; 79: 667-677
        • Kumar K.
        • Taylor R.S.
        • Jacques L.
        • et al.
        Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome.
        Pain. 2007; 132: 179-188
        • Kumar K.
        • Taylor R.S.
        • Jacques L.
        • et al.
        The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation.
        Neurosurgery. 2008; 63 ([discussion 770]): 762-770
        • North R.B.
        • Kidd D.H.
        • Farrokhi F.
        • Piantadosi S.A.
        Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial.
        Neurosurgery. 2005; 56 ([discussion 106–107]): 98-106
        • Petersen E.A.
        • Stauss T.G.
        • Scowcroft J.A.
        • et al.
        Effect of high-frequency (10-kHz) spinal cord stimulation in patients with painful diabetic neuropathy: a randomized clinical trial.
        JAMA Neurol. 2021; 78: 687-698
        • Abejon D.
        • Rueda P.
        • Parodi E.
        • Del Saz J.
        Effects of movement and postural positions in spinal cord stimulation in the new rechargeable systems.
        Pain Physician. 2014; 17: 345-352
        • Al-Kaisy A.
        • Van Buyten J.P.
        • Smet I.
        • Palmisani S.
        • Pang D.
        • Smith T.
        Sustained effectiveness of 10 kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study.
        Pain Med. 2014; 15: 347-354
        • Al-Kaisy A.
        • Palmisani S.
        • Smith T.E.
        • et al.
        Long-term improvements in chronic axial low back pain patients without previous spinal surgery: a cohort analysis of 10-kHz high-frequency spinal cord stimulation over 36 months.
        Pain Med. 2018; 19: 1219-1226
        • Al-Kaisy A.
        • Palmisani S.
        • Carganillo R.
        • et al.
        Safety and efficacy of 10 kHz spinal cord stimulation for the treatment of refractory chronic migraine: a prospective long-term open-label study.
        Neuromodulation. 2022; 25: 103-113
        • Allegri M.
        • Arachi G.
        • Barbieri M.
        • et al.
        Prospective study of the success and efficacy of spinal cord stimulation.
        Minerva Anestesiol. 2004; 70: 117-124
        • Aló K.M.
        • Yland M.J.
        • Charnov J.H.
        • Redko V.
        Multiple program spinal cord stimulation in the treatment of chronic pain: follow-up of multiple program SCS.
        Neuromodulation. 1999; 2: 266-272
        • Aló K.M.
        • Redko V.
        • Charnov J.
        Four year follow-up of dual electrode spinal cord stimulation for chronic pain.
        Neuromodulation. 2002; 5: 79-88
        • Amirdelfan K.
        • Vallejo R.
        • Benyamin R.
        • et al.
        High-frequency spinal cord stimulation at 10 kHz for the treatment of combined neck and arm pain: results from a prospective multicenter study.
        Neurosurgery. 2020; 87: 176-185
        • Barolat G.
        • Oakley J.C.
        • Law J.D.
        • North R.B.
        • Ketcik B.
        • Sharan A.
        Epidural spinal cord stimulation with a multiple electrode paddle lead is effective in treating intractable low back pain.
        Neuromodulation. 2001; 4: 59-66
        • Burchiel K.J.
        • Anderson V.C.
        • Brown F.D.
        • et al.
        Prospective, multicenter study of spinal cord stimulation for relief of chronic back and extremity pain.
        Spine (Phila Pa 1976). 1996; 21: 2786-2794
        • Burgher A.
        • Kosek P.
        • Surrett S.
        • et al.
        Ten kilohertz SCS for treatment of chronic upper extremity pain (UEP): results from prospective observational study.
        J Pain Res. 2020; 13: 2837-2851
        • de Vos C.C.
        • Dijkstra C.
        • Lenders M.W.
        • Holsheimer J.
        Spinal cord stimulation with hybrid lead relieves pain in low back and legs.
        Neuromodulation. 2012; 15 ([discussion 123]): 118-123
        • Deer T.
        • Skaribas I.
        • Nelson C.
        • et al.
        Interim results from the partnership for advancement in neuromodulation pain registry.
        Neuromodulation. 2014; 17: 656-664
        • Deer T.
        • Skaribas I.
        • McJunkin T.
        • et al.
        Results from the partnership for advancement in neuromodulation registry: a 24-month follow-up.
        Neuromodulation. 2016; 19: 179-187
        • El Majdoub F.
        • Neudorfer C.
        • Richter R.
        • Schieferdecker S.
        • Maarouf M.
        10 kHz cervical SCS for chronic neck and upper limb pain: 12 months’ results.
        Ann Clin Transl Neurol. 2019; 6: 2223-2229
        • Liem L.
        • Russo M.
        • Huygen F.J.
        • et al.
        One-year outcomes of spinal cord stimulation of the dorsal root ganglion in the treatment of chronic neuropathic pain.
        Neuromodulation. 2015; 18 ([discussion 48–49]): 41-48
        • Rapcan R.
        • Mlaka J.
        • Venglarcik M.
        • Vinklerova V.
        • Gajdos M.
        • Illes R.
        High-frequency — spinal cord stimulation.
        Bratisl Lek Listy. 2015; 116: 354-356
        • Rigoard P.
        • Delmotte A.
        • D'Houtaud S.
        • et al.
        Back pain: a real target for spinal cord stimulation?.
        Neurosurgery. 2012; 70 ([discussion 584–585]): 574-584
        • Russo M.
        • Brooker C.
        • Cousins M.J.
        • et al.
        Sustained long-term outcomes with closed-loop spinal cord stimulation: 12-month results of the prospective, multicenter, open-label Avalon study.
        Neurosurgery. 2020; 87: E485-E495
        • Sarubbo S.
        • Latini F.
        • Tugnoli V.
        • Quatrale R.
        • Granieri E.
        • Cavallo M.A.
        Spinal anesthesia and minimal invasive laminotomy for paddle electrode placement in spinal cord stimulation: technical report and clinical results at long-term followup.
        ScientificWorldJournal. 2012; 2012: 201053
        • Van Buyten J.P.
        The performance and safety of an implantable spinal cord stimulation system in patients with chronic pain: a 5-year study.
        Neuromodulation. 2003; 6: 79-87
        • Van Buyten J.P.
        • Fowo S.
        • Spincemaille G.H.
        • et al.
        The restore rechargeable, implantable neurostimulator: handling and clinical results of a multicenter study.
        Clin J Pain. 2008; 24: 325-334
        • Verrills P.
        • Salmon J.
        • Russo M.
        • Gliner B.
        • Barnard A.
        • Caraway D.
        10 kHz spinal cord stimulation for chronic upper limb and neck pain: Australian experience.
        Eur Spine J. 2020; 29: 2786-2794
        • Elzahaf R.A.
        • Tashani O.A.
        • Unsworth B.A.
        • Johnson M.I.
        The prevalence of chronic pain with an analysis of countries with a Human Development Index less than 0.9: a systematic review without meta-analysis.
        Curr Med Res Opin. 2012; 28: 1221-1229
        • Dahlhamer J.
        • Lucas J.
        • Zelaya C.
        • et al.
        Prevalence of chronic pain and high-impact chronic pain among adults — United States, 2016.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 1001-1006
        • Leverence R.R.
        • Williams R.L.
        • Potter M.
        • et al.
        Chronic non-cancer pain: a siren for primary care—a report from the PRImary Care MultiEthnic Network (PRIME Net).
        J Am Board Fam Med. 2011; 24: 551-561
        • Tölle T.
        • Xu X.
        • Sadosky A.B.
        Painful diabetic neuropathy: a cross-sectional survey of health state impairment and treatment patterns.
        J Diabetes Complications. 2006; 20: 26-33
        • van Seventer R.
        • Sadosky A.
        • Lucero M.
        • Dukes E.
        A cross-sectional survey of health state impairment and treatment patterns in patients with postherpetic neuralgia.
        Age Ageing. 2006; 35: 132-137
        • Bergés I.M.
        • Ottenbacher K.J.
        • Smith P.M.
        • Smith D.
        • Ostir G.V.
        Perceived pain and satisfaction with medical rehabilitation after hospital discharge.
        Clin Rehabil. 2006; 20: 724-730
        • Rubin H.R.
        • Gandek B.
        • Rogers W.H.
        • Kosinski M.
        • McHorney C.A.
        • Ware J.E.
        Patients’ ratings of outpatient visits in different practice settings. Results from the Medical Outcomes Study.
        JAMA. 1993; 270: 835-840
        • Hall J.A.
        • Dornan M.C.
        Meta-analysis of satisfaction with medical care: description of research domain and analysis of overall satisfaction levels.
        Soc Sci Med. 1988; 27: 637-644
        • Scher C.
        • Meador L.
        • Van Cleave J.H.
        • Reid M.C.
        Moving beyond pain as the fifth vital sign and patient satisfaction scores to improve pain care in the 21st Century.
        Pain Manag Nurs. 2018; 19: 125-129