Invasive Spinal Neuromodulation for Chronic Pain in Pediatric Patients: A Scoping Review

OBJECTIVE: Chronic pain affects up to 21% of pediatric patients and significantly impairs function and quality of life. Although spinal neuromodulation, including spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRG-S), has demonstrated efficacy in adults, evidence in children remains limited. This scoping review aims to systematically evaluate current evidence on spinal neuromodulation for pediatric chronic pain patients, focusing on clinical indications, outcomes, and safety. METHODS: A structured scoping review was conducted using PubMed/MEDLINE and Scopus databases on June 8, 2025. Studies were included if they reported on patients under 21 years undergoing SCS or DRG-S for chronic pain. Two independent reviewers screened articles and extracted data on demographics, diagnoses, interventions, outcomes, and follow-up. RESULTS: Out of 706 references, 17 studies met inclusion criteria. Of those, 16 reported on SCS and 1 reported on DRG-S. complex regional pain syndrome (CRPS) was the most common indication, with most patients reporting substantial pain reduction, improved functional outcomes, and decreased medication use. Erythromelalgia was another frequent diagnosis treated successfully with SCS, demonstrating significant reductions in pain, swelling, and erythema. Other conditions included recurrent tethered cord syndrome, neurogenic thoracic outlet syndrome, lymphangioma, postoperative neuropathic pain, and genetic syndromes. Overall, most patients experienced meaningful improvements in pain and daily functioning, with few major complications reported. CONCLUSIONS: Spinal neuromodulation, predominantly SCS, appears to be a promising adjunctive therapy for refractory chronic pain in pediatric patients, particularly for CRPS and erythromelalgia. Despite encouraging findings, the evidence remains limited to small series and case reports. High-quality prospective studies are needed to establish long-term safety, efficacy, and optimal patient selection in this vulnerable population.