The Impact of Biological Sex on the Outcomes of Spinal Cord Stimulation in Patients with Chronic Pain

Pain Practice ◽  
2021 ◽  
Author(s):  
Nagy Mekhail ◽  
Shrif Costandi ◽  
Youssef Saweris ◽  
Sherif Armanyous ◽  
Gaurave Chauhan
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Biological Sex ◽  
The Impact

scholarly journals Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 193-201
Author(s):  
Syed M Adil ◽  
Lefko T Charalambous ◽  
Charis A Spears ◽  
Musa Kiyani ◽  
Sarah E Hodges ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Dose Reduction ◽  
Spinal Cord Stimulation ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Patient Centered ◽  
Opioid Dose ◽  
The Impact

Abstract BACKGROUND Opioid misuse in the USA is an epidemic. Utilization of neuromodulation for refractory chronic pain may reduce opioid-related morbidity and mortality, and associated economic costs. OBJECTIVE To assess the impact of spinal cord stimulation (SCS) on opioid dose reduction. METHODS The IBM MarketScan® database was retrospectively queried for all US patients with a chronic pain diagnosis undergoing SCS between 2010 and 2015. Opioid usage before and after the procedure was quantified as morphine milligram equivalents (MME). RESULTS A total of 8497 adult patients undergoing SCS were included. Within 1 yr of the procedure, 60.4% had some reduction in their opioid use, 34.2% moved to a clinically important lower dosage group, and 17.0% weaned off opioids entirely. The proportion of patients who completely weaned off opioids increased with decreasing preprocedure dose, ranging from 5.1% in the >90 MME group to 34.2% in the ≤20 MME group. The following variables were associated with reduced odds of weaning off opioids post procedure: long-term opioid use (odds ratio [OR]: 0.26; 95% CI: 0.21-0.30; P < .001), use of other pain medications (OR: 0.75; 95% CI: 0.65-0.87; P < .001), and obesity (OR: 0.75; 95% CI: 0.60-0.94; P = .01). CONCLUSION Patients undergoing SCS were able to reduce opioid usage. Given the potential to reduce the risks of long-term opioid therapy, this study lays the groundwork for efforts that may ultimately push stakeholders to reduce payment and policy barriers to SCS as part of an evidence-based, patient-centered approach to nonopioid solutions for chronic pain.

scholarly journals The impact of the COVID-19 pandemic on patients awaiting spinal cord stimulation surgery in the United Kingdom: a multi-centre patient survey

2020 ◽  
pp. 204946372094809
Author(s):  
Ganesan Baranidharan ◽  
Beatrice Bretherton ◽  
Sam Eldabe ◽  
Vivek Mehta ◽  
Simon Thomson ◽  
...  
Keyword(s):  
Mental Health ◽  
Spinal Cord ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
Patient Survey ◽  
Support Network ◽  
Chi Square ◽  
Medication Consumption ◽  
The Impact

Introduction: Spinal cord stimulation (SCS) is a recommended treatment for chronic refractory neuropathic pain. During the COVID-19 pandemic, elective procedures have been postponed indefinitely both to provide capacity to deal with the emergency caseload and to avoid exposure of elective patients to COVID-19. This survey aimed to explore the effect of the pandemic on chronic pain in this group and the views of patients towards undergoing SCS treatment when routine services should resume. Methods: This was a prospective, multi-centre telephone patient survey that analysed data from 330 patients with chronic pain who were on an SCS waiting list. Questions focussed on severity of pain, effect on mental health, medication consumption and reliance on support networks during the COVID-19 pandemic. Views towards undergoing SCS therapy were also ascertained. Counts and percentages were generated, and chi-square tests of independence explored the impact of COVID-19 risk (very high, high, low) on survey responses. Results: Pain, mental health and patient’s ability to self-manage pain deteriorated in around 47%, 50% and 38% of patients, respectively. Some patients reported increases in pain medication consumption (37%) and reliance on support network (41%). Patients showed a willingness to attend for COVID-19 testing (92%), self-isolate prior to SCS (94%) and undergo the procedure as soon as possible (76%). Conclusion: Our findings suggest that even during the COVID-19 pandemic, there remains a strong clinical need for patients with chronic pain identified as likely SCS responders to be treated quickly. The current prioritisation of new SCS at category 4 (delayed more than 3 months) is challenged judging by this national survey. These patients are awaiting SCS surgery to relieve severe intractable neuropathic pain. A priority at category 3 (delayed up to 3 months) or in some selected cases, at category 2 are the appropriate priority categories.

Retrospective analysis on the effect of spinal cord stimulation on opioid consumption

2020 ◽  
Author(s):  
Awinita Barpujari ◽  
Michael A Erdek
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Retrospective Analysis ◽  
Spinal Cord Stimulation ◽  
Alternative Therapy ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Number Of Patients ◽  
Chronic Pain Conditions ◽  
Post Trial

Aim: Spinal cord stimulation (SCS) is used to clinically manage and/or treat several chronic pain etiologies. A limited amount is known about the influence on patients' use of opioid pain medication. This retrospective analysis evaluated SCS effect on opioid consumption in patients presenting with chronic pain conditions. Materials & methods: Sixty-seven patients underwent a temporary trial device, permanent implant or both. Patients were divided for assessment based on the nature of their procedure(s). Primary outcome was change in morphine equivalent dose (MED), ascertained from preoperative and postoperative medication reports. Results: Postoperative MED was significantly lower in patients who received some form of neuromodulation therapy. Pretrial patients reported an average MED of 41.01 ± 10.23 mg per day while post-trial patients reported an average of 13.30 ± 5.34 mg per day (p < 0.001). Pre-implant patients reported an average MED of 39.14 ± 13.52 mg per day while post-implant patients reported an average MED of 20.23 ± 9.01 mg per day (p < 0.001). There were no significant differences between pre-trial and pre-implant MED, nor between post-trial and post-implant MED. Of the 42 study subjects who reported some amount of pre-intervention opioid use, 78.57% indicated a lower MED (n = 33; p < 0.001), 16.67% indicated no change (n = 7) and 4.76% (n = 2) indicated a higher MED, following intervention. Moreover, SCS therapy resulted in a 26.83% reduction (p < 0.001) in the number of patients with MED >50 mg per day. Conclusion: Spinal cord stimulation may reduce opioid use when implemented appropriately. Neuromodulation may represent alternative therapy for alleviating chronic pain which may avoid a number of deleterious side effects commonly associated with opioid consumption.

Spinal Cord Stimulation for Relief of Chronic Pain in Vasospastic Disorders of the Upper Limbs

1989 ◽  
Vol 5 (2) ◽  
pp. 312
Author(s):  
F. J. ROBAINA ◽  
M. DOMINGUEZ ◽  
M. DIAZ ◽  
J. L. RODRIGUEZ ◽  
J. A. DE VERA
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Upper Limbs

Spinal Cord Stimulation: A Contemporary Series

Neurosurgery ◽  
1991 ◽  
Vol 28 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Roberto Spiegelmann ◽  
William A. Friedman
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Pain Relief ◽  
Literature Review ◽  
General Anesthesia ◽  
Detailed Analysis ◽  
Spinal Cord Stimulation ◽  
Significant Pain ◽  
Experience Pain

Abstract Forty-three patients with chronic pain disorders of different causes were selected for spinal cord stimulation. All underwent implantation of a ribbon electrode through a small laminotomy, under general anesthesia. Thirteen patients (30%) failed to obtain significant pain relief during a period of trial stimulation, and their electrodes were removed. The remainder underwent a definitive implant and were followed for a mean of 13 months (range, 3-33 months). Nineteen of them (63%) continued to experience pain relief. A detailed analysis of this series, as well as a literature review, is presented.

Duloxetine Improves Spinal Cord Stimulation Outcomes for Chronic Pain

2018 ◽  
Vol 22 (2) ◽  
pp. 215-218 ◽  
Author(s):  
Tarun Prabhala ◽  
Shelby Sabourin ◽  
Marisa DiMarzio ◽  
Michael Gillogly ◽  
Julia Prusik ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation

scholarly journals High Frequency Spinal Cord Stimulation in a Patient with Bilateral Cochlear Implants

2021 ◽  
pp. 189-191
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Pain Relief ◽  
Cochlear Implant ◽  
Cochlear Implants ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Pain Clinic ◽  
Bilateral Cochlear Implants ◽  
Patient Reported

BACKGROUND: High-frequency spinal cord stimulation (HF-SCS) has become very popular in the management of chronic pain worldwide. As it relies on generating high-frequency electrical impulses, there is a risk of interference with other devices such as cochlear implants that utilize similar principles. A literature search did not reveal any case reports of HF-SCS implantation in a patient with cochlear implants. CASE REPORT: A 75-year-old White woman with a history of bilateral cochlear implants (Cochlear Americas Nucleus® with cp910 processor) for severe sensorineural hearing loss presented to our chronic pain clinic with lumbosacral radiculopathy. The patient underwent a HF-SCS trial with entry point at the L1-L2 space and the leads positioned at the top and bottom of T8. The patient did not experience any auditory interference with her Cochlear implant at triple the average SCS stimulation strength. During the follow-up visit the next week, the patient reported nearly 80% symptomatic pain relief and significant functional improvement. There was no change in her hearing and no evidence of interference. The patient ultimately underwent percutaneous SCS paddle electrode placement and at 3 months, continues to have excellent pain relief without any auditory interactions. CONCLUSION: We successfully implanted a HF-SCS at the thoracic level in a patient with bilateral cochlear implants without any auditory interference. KEY WORDS: Cochlear implant, lumbar radiculopathy, spinal cord stimulation

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