A recently published systematic review and network meta-analysis, led by Lisa Goudman and co-authored by Dr. Marc Russo et al., evaluates the effectiveness of various treatment approaches for PSPS-T2, including neuromodulation, minimally invasive techniques, conservative therapies, and surgery. With 49 studies reviewed and 13 included in the meta-analysis, the findings highlight neuromodulation—especially spinal cord stimulation—as a leading option for pain relief, though treatment should always be tailored to individual patient histories and responses.
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Commun Med (Lond) 2025 Mar 5;5(1):63. doi: 10.1038/s43856-025-00778-x.
Treatment modalities for patients with Persistent Spinal Pain Syndrome Type II: A systematic review and network meta-analysis
Lisa Goudman, Marc Russo, et al.
PMID: 40044846 DOI: 10.1038/s43856-025-00778-x
Abstract
Background: Appropriate management of patients with Persistent Spinal Pain Syndrome Type 2 (PSPS-T2) remains challenging. The need for robust evidence for treatment modalities is urgently pressing. The aim of this systematic review and network meta-analysis (NMA) is to compare different treatment modalities for patients with PSPS-T2 on pain intensity.
Methods: The study protocol was prospectively registered (PROSPERO;CRD42022360160). Four different databases were consulted from database inception to December 18th, 2023. Randomised controlled trials of interventions for PSPS-T2 were included. The revised Cochrane Risk of Bias Tool was used to assess risk of bias. A NMA with standardized mean differences was calculated with pairwise comparisons between all treatment modalities.
Results: Here we include 49 studies in the systematic review and 13 in NMA. A high risk of bias is indicated for 65.3% of the studies. Half of the studies investigate neuromodulation (mainly Spinal Cord Stimulation), 16 explore minimal invasive treatment options (predominantly epidural injections), 6 studies focus on conservative treatments (physiotherapy/cognitive training and medication) and 2 on reoperation. Comparison of neuromodulation versus a combination of conservative and minimal invasive options results in an effect size of 0.45 (95% CI: 0.14-0.76), clearly favouring neuromodulation (z = 2.88; p = 0.004). Additionally, neuromodulation results in a standardised mean difference of 0.36 (95% CI: 0.18-0.53) compared to placebo/sham (z = 4.03; p < 0.0001). No statistically significant difference is found between conservative options and neuromodulation.
Conclusions: Neuromodulation, followed by conservative treatment options, seems to be the most effective treatment option to obtain pain relief in patients with PSPS-T2. Nevertheless, a personalized approach tailored to individual patient needs is essential for optimizing outcomes, since interventions should be adjusted based on the failure or success of prior therapies.
Click here to view the full article: https://pubmed.ncbi.nlm.nih.gov/40044846/