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Randomised clinical trials (RCTs) are considered the gold standard for evaluating the efficacy of healthcare interventions, although the presence of conflicts of interest (COIs) may potentially compromise the scientific integrity of these trials. This article 1 highlights the pervasive issue of COIs in RCTs studying spinal cord stimulation (SCS) for chronic pain. Analysing 38 trials published between 2013 and 2023, D’Souza et al 1 found that 78.9% of these trials reported COIs, with an average of 35.6% of authors per RCT having at least one COI. The monetary value of these conflicts averaged $41 157.83 per author annually. Concerningly, 76.3% of RCTs had undisclosed conflicts, with an average of 24.2% of authors per RCT having an undisclosed COI. These findings emphasize the need for rigorous COI disclosure policies and enhanced global transparency systems to mitigate potential biases in neuromodulation research.