Socioeconomic Determinants of Initiating Neuromodulation for Chronic Pain: A Systematic Review.

Objectives: Neuromodulation is an effective treatment for chronic pain; however, socioeconomic differences may influence decision-making to initiate this therapy. This review investigated potential differences in accessibility of neuromodulation for patients with chronic pain due to socioeconomic determinants.
Materials and Methods: Four electronic databases were used for this systematic review: MEDLINE, Embase, Scopus, and Web of Science. Risk of bias was assessed using the modified version of the Downs and Black checklist. The study protocol was prospectively registered on PROSPERO (CRD42023426035).
Results: The initial database search identified a total of 1118 unique studies, of which 36 were eventually included in the systematic review. Of the 36 included studies, six studies reported on education, 24 on employment status, ten on insurance, five on household income, and three on miscellaneous topics. Neuromodulation seems accessible for patients with different education levels and different types of insurance. Additionally, it is not restricted to patients who are (un)employed. When comparing patients who initiated neuromodulation with those who did not, a significantly higher number of patients in the top quartile for education were found in the group without neuromodulation. Regarding insurance, inconclusive evidence was found.
Conclusions: Although neuromodulation was accessible for patients with varying levels of socioeconomic determinants, disparities were noted. When comparing the socioeconomic profiles of patients who receive neuromodulation and those who do not, education levels differ. Health-related inequality should be carefully monitored in chronic pain management with neuromodulation to ensure that potential disparities do not increase.
Competing Interests: Conflict of Interest Maarten Moens has received speaker fees from Medtronic. Julie G. Pilitsis receives grant support from Medtronic, Boston Scientific, Abbott, and the National Institutes of Health (2R01CA166379, R01EB030324, and U44NS115111). She is the medical advisor for AiM Medical Robotics and has stock equity. Lawrence Poree has consulted for Medtronic, Nalu, and Saluda. Philippe Rigoard reports grants and consultant fees from Medtronic, Abbott, and Boston Scientific, outside the submitted work. Lisa Goudman is a postdoctoral research fellow funded by the Research Foundation – Flanders, Belgium (project number 12ZF622N). The STIMULUS research group received independent research grants from Medtronic. There are no other conflicts of interest to declare.
(Copyright © 2024 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.)