The Effectiveness of Interventional Neuromodulation in Reducing Opioids Use: A Systematic Review and Meta-Analysis

Background:

Chronic pain poses a significant challenge to patient well-being and treatment refractory pain has been well understood to be a significant contributor towards opioid usage. Neuromodulation offers a promising alternative, aiming to reduce pain and pharmacological dependency, though more research is needed on its efficacy in opioid reduction. A systematic review and meta-analysis identified ten studies showing varying degrees of reduced opioid use post-neuromodulation, highlighting the need for further investigation to understand the impact of neuromodulation on opioid management comprehensively.

Discussion: 

Results showed heterogeneous reduction and/or elimination of opioid use amongst all studies (I^2 = 87.55%, p<0.001). However, further meta-analysis of treatment comparisons of four studies that reported opioid use outcomes in post-neuromodulation and conventional medical management (CMM) cohorts showed an increased odds ratio of opioid reduction in patients treated with neuromodulation versus CMM (I^2 = 45.79%, p = 0.137). There were limited studies that included opioid use data for both treatment and control groups; however, all studies reported an increased proportion of reduction in opioid use in the post-neuromodulation cohort. We recommend further studies to closely follow-up opioid use in patients after neuromodulation and record ancillary parameters such as baseline and follow-up morphine milligram equivalent (MME) to further characterize the effectiveness of neuromodulation on reducing opioid use.