Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis.
Abstract
<h4>Background</h4>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.<h4>Objective</h4>To assess the impact of spinal cord stimulation
(SCS) on opioid dose reduction.<h4>Methods</h4>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).<h4>Results</h4>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).<h4>Conclusion</h4>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.
Type
Journal articleSubject
HumansOpioid-Related Disorders
Analgesics, Opioid
Retrospective Studies
Adult
Middle Aged
Female
Male
Pain Management
Chronic Pain
Spinal Cord Stimulation
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https://hdl.handle.net/10161/23905Published Version (Please cite this version)
10.1093/neuros/nyaa353Publication Info
Adil, Syed M; Charalambous, Lefko T; Spears, Charis A; Kiyani, Musa; Hodges, Sarah
E; Yang, Zidanyue; ... Lad, Shivanand P (2020). Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis.
Neurosurgery, 88(1). pp. 193-201. 10.1093/neuros/nyaa353. Retrieved from https://hdl.handle.net/10161/23905.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Shivanand Lad
Professor of Neurosurgery
Dr. Nandan Lad is a neurosurgeon, scientist, and entrepreneur and Professor and Vice
Chair of Innovation for Duke Neurosurgery. He is Director of the Functional & Restorative
Neuromodulation Program and the Duke NeuroInnovations Program, a systematic approach
to innovation to large unmet clinical needs. He completed his MD and PhD in Biochemistry
at Chicago Medical School and his neurosurgical residency training at Stanford with
fellowships in both Surgical Innovation and
Lexie Zidanyue Yang
Biostatistician II
Education: Masters Degree, Biostatistics. Duke University School of Medicine. 2018
Overview: Lexie collaborates with doctors, residents, and fellows in the Department
of Neurosurgery and Department of Pharmacy. She has strong experience in data management
with large databases, such as MarketScan and HCUP. She has also worked with EHR data
and CRDM. Her statistical interests include longitudinal analysis, mediation analysis,
survival analysis and latent class analysis.<br /
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