Spinal Cord Stimulation in Pediatric Complex Regional Pain Syndrome: A Literature Review

TL;DR

This paper reviews spinal cord stimulation as a treatment for chronic pain in adolescents, showing it can reduce pain and medication use but needs more research.

Contribution

The paper provides a comprehensive review of spinal cord stimulation's efficacy and safety in treating pediatric complex regional pain syndrome.

Findings

SCS reduces pain scores from 9.2 to 2.9 and improves school attendance and physical activity.

Medication reliance decreases by 50%-60%, including opioids, with effects lasting up to eight years.

Complications occur in 16.7% of cases, mainly during trial phases, but research is limited by small sample sizes.

Abstract

Complex regional pain syndrome (CRPS) is a chronic pain condition causing severe pain, sensory disturbances, and functional impairments, disproportionately affecting adolescent females. Spinal cord stimulation (SCS) has emerged as a promising modality for managing refractory CRPS in pediatric patients, offering sustained pain relief and improved quality of life. This literature review evaluates SCS’s efficacy, safety, and functional outcomes in this population, identifies evidence gaps, and provides recommendations for future research. Comprehensive searches were conducted in PubMed, EMBASE, Scopus, Medline, Web of Science, and the Cochrane Central Register of Controlled Trials, including randomized controlled trials, prospective studies, case series, and case reports, focused on pain relief, functional improvement, medication use, and quality of life.

Findings indicate SCS significantly reduces pain, such as Visual Analog Scale scores dropping from 9.2 to 2.9; enhances function, including improved school attendance and physical activity; and decreases medication reliance by 50%-60%, including opioids, with benefits sustained over six months to eight years. Complications, such as cerebrospinal fluid leaks and infections, occur in 16.7% of cases, primarily during trial phases. However, small sample sizes of 7-15 patients, retrospective designs, and a lack of randomized controlled trials limit generalizability. Ethical challenges, including informed consent and device maintenance in growing children, further complicate adoption. Future research should prioritize large-scale, multicenter trials with extended follow-up to confirm long-term outcomes, optimize stimulation parameters, and explore cost-effectiveness. SCS’s success suggests potential applicability to other pediatric pain syndromes, offering an opioid-sparing alternative that addresses both physical and psychosocial dimensions of CRPS, ultimately enhancing well-being in this vulnerable population.