265: Neuromodulation for chronic pain: A systematic evidence/gap map on adherence to outcome frameworks

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Assessment and Measurement of Pain/Nociception, Neuromodulation (e.g. TMS, TDCS, FUS, SCS, MCS, DBS, vagus nerve stimulation)

Background and Aims: Neuromodulation is increasingly used in chronic pain management across regions, yet the global distribution of evidence and the outcomes prioritised in research remain unclear. Evidence and gap maps (EGMs) provide a structured approach to identify evidence concentration and critical gaps. We aimed to develop an EGM evaluating neuromodulation for adults with chronic pain.

Methods: A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, and Scopus. Eligible studies included randomized controlled trials, non-randomized trials, prospective cohort studies, and systematic reviews on neuromodulation in adults with chronic pain. Data extraction covered neuromodulation modality, study characteristics, and outcome measures. Outcomes were categorized into physical, emotional, and social domains according to IMMPACT, VAPAIN, and PROMIS frameworks. Methodological quality was assessed using AMSTAR-2 (reviews) and a modified Downs and Black checklist (primary studies). Results were synthesised in an open-access interactive EGM enabling exploration by intervention, outcome domain, study design, continent, funding, quality, and year.

Results: A total of 671 studies were included. Most studies evaluated spinal cord stimulation (35.3%), followed by transcutaneous electrical nerve stimulation (15.3%) and transcranial direct current stimulation (13.9%). Physical health outcomes, including pain intensity (93.6%) and physical functioning (58.3%), dominated the literature, whereas social, and economic outcomes were underrepresented (<10%). These imbalances were consistent across outcome frameworks and geographical regions.

Conclusions: The global evidence base for neuromodulation in chronic pain is unevenly distributed across modalities and outcome domains, with limited attention to psychosocial and economic dimensions that are central to health equity and policy decision-making. Greater adoption of standardised, multidimensional outcome frameworks is needed to align neuromodulation research with patient priorities and societal impact. The interactive EGM provides a living resource to support evidence-informed clinical, research, and policy decisions globally.

References: Online application: https://lisagoudman.shinyapps.io/werkmap_research/.

Presenting Author: Lisa Goudman
Submitting Author: Lisa Goudman

Senior Author: Lisa Goudman & Maarten Moens

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Patrice Forget: MD PhD - University of Aberdeen
• Dominic Hegarty: MD - University College Cork
• Ryan D’Souza: MD - Mayo Clinic
• Jan Vollert: MSc PhD - University of Exeter
• Julie G Pilitsis: MD PHD MBA - University of Arizona
• Maxime Billot: MSc PhD - Poitiers University
• Philippe Rigoard: MD PhD - Poitiers University
• Maarten Moens: MD PhD - Vrije Universiteit Brussel