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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Adil, SM; Charalambous, LT; Spears, CA; Kiyani, M; Hodges, SE; Yang, Z; Lee, H-J; Rahimpour, S; Parente, B; Greene, KA; McClellan, M; Lad, SP

Published Date

  • December 15, 2020

Published In

Volume / Issue

  • 88 / 1

Start / End Page

  • 193 - 201

PubMed ID

  • 32866229

Pubmed Central ID

  • 32866229

Electronic International Standard Serial Number (EISSN)

  • 1524-4040

Digital Object Identifier (DOI)

  • 10.1093/neuros/nyaa353

Language

  • eng

Conference Location

  • United States