Background: Intrathecal drug delivery (IDD) is part of the fourth analgesic step. Evidence on the quality of life of patients with refractory chronic non-cancer pain (CNCP) using these devices and their long-term outcomes is scarce. This study aims to evaluate patients with IDD to assess their HRQoL. Additionally, the study seeks to understand the patients’ satisfaction with the treatment and changes in pain magnitude over time. Methods: Adult patients with CNCP and intrathecal drug delivery systems (IDDS) were included. The study population was divided into two groups: less than and more than 15 years of treatment. HRQoL was analyzed using validated questionnaires. Pain reduction was assessed using the visual analog scale (VAS), and treatment satisfaction was evaluated using the Patient Global Impression of Improvement scale. Results: The results indicate a poor HRQoL in IDD patients, with better scores in the group with ≥15 years of treatment. Pain reduction was similar in both groups, and patients reported a positive satisfaction level with the treatment. Conclusions: HRQoL in CNCP patients is severely affected. Long-term IDD patients have a similar or even better HRQoL in some respects compared to those with shorter follow-ups. IDD patients experienced pain reduction, with most feeling better or much better.

Background: Spinal cord stimulation (SCS) is a well-established treatment for chronic neuropathic pain, offering a safe procedure with low complication rates. Both surgical and percutaneous leads can be effective, with similar complication rates. Methods: We analyzed all patients implanted at a reference center since 1996 to compare pain control and complications and determine whether one system was more effective than the other in patients who had experienced both systems. A retrospective observational study was designed. Results: A total of 188 SCS systems were implanted, with a follow-up period of 79.71 ± 60.39 months (mean ± SD). We analyzed data from 106 males (56.38%) and 82 females (43.62%), ranging from 15 to 76 years old. A total of 68 (36.17%) surgical leads and 120 (63.83%) percutaneous leads were implanted for failed back syndrome (120, 63.83%), complex regional pain syndrome (56, 29.79%), and other conditions (12, 6.38%). No statistically significant differences were found in any variables except for lead migration (p = 0.05). In patients who initially had a percutaneous system and later received a surgical system, we found a statistically significant difference in pain relief percentage (p = 0.03) and a trend toward statistical significance in the PGI-C score (p = 0.08). Conclusions: Both surgical and percutaneous leads have demonstrated similar pain control rates, but percutaneous leads have a higher migration rate. Complications can be minimized by performing the procedure in specialized centers with extensive experience. Further studies comparing both systems should be conducted to determine if one type of lead is superior.

Background: Spinal cord stimulation (SCS) is an established therapy for chronic neuropathic pain. Although rechargeable and non-rechargeable pulse generators (PGs) are widely used, their real-world battery life and the influence of lead type on energy efficiency remain underexplored. Objective: To evaluate PG battery longevity and compare the performance of surgical versus percutaneous leads in terms of energy efficiency. Methods: We conducted a retrospective study of 283 PGs implanted at Hospital Virgen de las Nieves (Granada, Spain) from 1996 to 2023. Data on patient demographics, pain etiology, lead type and placement, stimulation modality, and PG status were extracted. A competing risks analysis was used to assess PG shutdown and early explantation over time. Results: Of the PGs analyzed, 43.5% were non-rechargeable and 56.5% rechargeable. Rechargeable PGs showed significantly longer battery life (mean: 82.7 vs. 38.9 months, p < 0.05), with a lower probability of shutdown at 50, 100, and 150 months. No significant differences in battery longevity were observed regarding lead location, stimulation type, or pain etiology. A trend toward longer battery life was observed with percutaneous leads, although not statistically significant. Conclusions: Rechargeable PGs demonstrated superior longevity compared to non-rechargeable models and should be considered the preferred option in most cases. While both surgical and percutaneous leads are effective, percutaneous systems may offer improved battery efficiency. Further prospective studies are warranted to confirm these findings and assess cost-effectiveness.

Background: Chronic low back pain (CLBP) is the leading cause of years lived with disability worldwide. Sleep disturbances are highly prevalent among patients with CLBP and may contribute to pain persistence, disability, and poorer treatment outcomes. Despite this, sleep remains an underrecognized component of routine clinical assessment. Objective: To review the available evidence on the relationship between sleep and CLBP, their shared pathophysiological mechanisms, clinical relevance, and implications for assessment and management in pain units. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and Google Scholar. Systematic reviews, meta-analyses, clinical trials, observational studies, and clinical practice guidelines addressing the relationship between sleep and CLBP, underlying mechanisms, and therapeutic strategies were included. Results: Sleep disturbances affect up to 73 % of patients with CLBP. Poor sleep quality is associated with worse clinical outcomes, greater disability, and a higher likelihood of central sensitization. The relationship between sleep and pain is bidirectional and involves alterations in endogenous pain modulation, hypothalamic–pituitary–adrenal axis dysregulation, and neuroinflammatory processes. Systematic assessment of sleep using structured clinical interviews and validated questionnaires may help identify patients with more complex clinical profiles. Among available interventions, cognitive behavioral therapy for insomnia (CBT-I) has the strongest supporting evidence. Several pharmacological treatments may improve sleep-related outcomes; however, their direct analgesic effects in CLBP appear limited. Conclusions: Sleep represents a clinically relevant dimension with important prognostic and therapeutic implications in CLBP. Routine assessment of sleep may help identify patients with greater clinical complexity and support a more individualized multimodal treatment approach. Integrating sleep evaluation into the routine management of CLBP may contribute to improved clinical and functional outcomes.

Background: Chronic pain is the leading cause of years lived with disability worldwide, with low back pain representing the most prevalent and disabling condition. Spinal cord stimulation (SCS) and intrathecal drug delivery (IDD) systems are established neuromodulation techniques for refractory chronic pain. However, a subset of patients experiences partial or declining benefit with either modality alone. In such cases, combined therapy may represent a rescue strategy. Methods: retrospective case series at a single center, including patients previously implanted with SCS who subsequently required IDD due to loss of efficacy or inadequate pain coverage. Pain intensity, opioid consumption, health-related quality of life, and patient satisfaction were assessed using validated instruments. Results: Twelve patients were included. Persistent low back pain with mixed nociceptive–neuropathic features was the most common indication. Combined therapy was observed in association with a mean reduction of 3.5 points on the Numeric Rating Scale, corresponding to an approximate 40% decrease in pain intensity. More than half of the patients discontinued systemic opioids. Complications occurred in seven patients (58.3%), mostly hardware-related and manageable with surgical revision; only one patient developed a device-related infection. Conclusions: In this case series, combined SCS and IDD therapy was observed in association with clinically meaningful pain reduction, decreased opioid use, and high patient-reported satisfaction. Although quality-of-life scores remained below population norms, patients consistently reported subjective improvement. Combined neuromodulation may represent a valid rescue option in selected patients with insufficient response to SCS alone.

The clinical case of a young patient with intractable residual limb pain is presented. Following the initial administration of opioids and subsequent overuse, the patient was switched to intrathecal (IT) ziconotide infusion with complete opioid withdrawal. After 15 years of treatment with ziconotide infusion, the patient achieved sustained analgesic control and excellent functional recovery. IT ziconotide showed good long‐term tolerability and safety.