Long-term effects of spinal cord stimulation combined with a physiotherapist-led exercise programme and physical activity on prescription for chronic neuropathic pain

OBJECTIVE: Assess the effects of spinal cord stimulation and add-on physical activity interventions on pain, physical activity levels, and health-related quality of life. DESIGN: Prospective single-arm. SUBJECTS/PATIENTS: 35 adults who underwent spinal cord stimulation device implantation for neuropathic pain completed the study. METHODS: Three months after implantation, participants initiated a 6-month individualized physiotherapist-led exercise programme, followed by 12 months of physical activity on prescription. Neuropathic pain intensity (Numeric Rating Scale, 0-10), physical activity (accelerometer), and health-related quality of life (EuroQol 5-dimensions, visual analogue scale, EQ-5D VAS; 0-100) were assessed at baseline and 3, 9, and 21 months after implantation. RESULTS: Neuropathic pain was reduced from baseline at 9 and 21 months (mean [SD] = 6.6 [1.7] at baseline; 4.8 [2.3] at 9 months, p = 0.003; 4.8 [2.1] at 21 months, p = 0.003). EQ-5D VAS scores increased significantly by 16 (p = 0.027) and 15 (p = 0.003) points at 9 and 21 months, respectively. No changes in physical activity were observed. Changes from 3 months were not statistically significant at 9 or 21 months for any outcomes. CONCLUSION: The initial effects of spinal cord stimulation on pain and health-related quality of life remained after the introduction of physical activity interventions, with no additional improvements observed beyond 3 months after implantation.