Cost-effectiveness of spinal cord stimulation: a long-term analysis of closed-loop scs in chronic pain treatment

Chronic low back pain is one of the leading causes of disability worldwide, and spinal cord stimulation (SCS) has emerged as a promising alternative for patients who do not respond to conventional treatments. SCS is a neuromodulation technique that inhibits pain transmission through electrical stimulation of the dorsal columns of the spinal cord. Recent technological innovations, including closed-loop SCS (CL-SCS) and multiphasic SCS, have significantly improved the precision and coverage of stimulation, resulting in better clinical outcomes and economic advantages. This integrative review aims to evaluate the efficacy and recent advances in spinal cord stimulation for patients with chronic back and leg pain. Ten relevant studies were analyzed, highlighting the superiority of the CL-SCS system in terms of both efficacy and cost-effectiveness. Despite high initial costs, studies suggest that CL-SCS becomes economically advantageous after five years due to its higher success rate in pain relief. On the other hand, multiphasic SCS provides broader stimulation coverage, leading to better pain control and improvements in patient quality of life. Additionally, non-invasive alternatives, such as transcutaneous direct spinal current stimulation (TSDCS), show potential as complementary or substitute therapies. The findings suggest that personalized therapy, incorporating various SCS modalities, may maximize patient outcomes. The continuous development of these techniques reinforces SCS as a key therapeutic intervention in managing chronic low back pain, providing sustained pain relief and improved quality of life.