Spinal Cord Stim Cuts Chronic Pain and Opioid Use

Spinal cord stimulation decreased pain in patients with chronic pain for more than a year, researchers reported, and also led to a decrease in these patients' use of opioids for pain control, a researcher reported.

In a retrospective study of 52 patients, overall pain was reduced 73% after a median follow-up of 15.6 months, reported Mayank Gupta, MD, of St. Luke's Cushing Memorial Hospital in Overland Park, Kansas, and the Kansas Pain Specialists in Leavenworth.

About 90% of the study patients reported that their pain level was reduced ≥50%, while half of the patients said their pain level was reduced >80% from baseline after spinal cord stimulation, he said in a presentation at the American Society for Interventional Pain Physicians virtual meeting.

While the study did not have have a standard protocol to reduce opioid utilization, about 24% of the patients tracked for use of controlled substances had a decrease in use, Gupta said.

"Real-world data set with multiple chronic pain etiologies shows clinically significant pain relief with 10kHz-spinal cord stimulation averaging for more than 12 months," Gupta's group noted in a poster presentation. "This pain relief was accompanied by indirect benefits, which included reduction in opioid use and in significant reduction in health care utilization."

Gupta reported that when pre-implantation and post-implantation periods were analyzed, there was a 50% reduction in emergency department (ED) visits, as well as an 80% reduction in procedures.

"Pharmacological treatment with opioids is usually involved early in the treatment pathway for chronic pain, but can result in side effects and substance abuse disorders," Gupta noted. "To avoid such side effects from opioid utilization, physicians are beginning to focus on minimally invasive, reversible interventional treatments such as spinal cord stimulation for certain chronic pain populations."

Yili Huang, DO, of the Pain Management Center at Northwell Health's Phelps Hospital in Sleepy Hollow, New York, commented that, "Spinal cord stimulation can be a cost-effective and efficacious treatment for many patients. In light of the ongoing opioid epidemic, it is important to increase awareness of this and other safe treatment options for patients with chronic pain."

"Spinal cord stimulation is an implantable device that uses electricity to simulate the spinal cord to potentially decrease the painful signal someone feels," explained Huang, who was not involved in the study. "It involves a temporary trial that is performed without surgery and, if successful, an implantation with very minor surgery. When used for the right patients, it can be very effective and can lead to decreased pain, disability and use of pain medications including opioids."

Gupta's group wanted to determine if 10kHz-spinal cord stimulation was effective in minimizing need for opioids and reducing healthcare utilization. Patients with a diagnosis of chronic pain were recruited from the electronic health records (EHR) at the Neuroscience Research Center in Overland Park, and underwent treatment with 10kHz spinal cord stimulation therapy from January 2017 to December 2019.

About 85% of the patients were being treated for lower back pain, while about 60% of the patients complained of leg pain, 16.7% said they were experiencing pain in the buttocks or hip, and 16.7% of the patients reported shoulder pain. Many patients experienced pain in several areas of their body.

Eligible patients had EHRs available before the implant and for at least 1 month post-implant. Gupta and colleagues reviewed data from the EHR and Kansas Tracking and Reporting of Controlled Substances Program databases. Healthcare utilization pre- and post-implant was obtained from EHR review and included clinic visits, interventional procedures, ED admissions, and surgical procedures.

Gupta's group also reported that most patients remained on stable opioid dose, but 24% decreased. Only 12% increased but still stayed on <15 morphine milligram equivalent (MME).

"For patients who receive spinal cord stimulator implants, the strongest predictor of whether they continue to use opioids is the amount of opioids the patients were using prior to the stimulator implant," Huang told MedPage Today. "Often, patients in chronic pain receive increasing doses of opioids to control their pain prior to the use of spinal cord stimulators. Therefore, early identification and consideration of spinal cord stimulator treatment for appropriate patients is the key to using this treatment to curb opioid use."

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