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

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.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1093/neuros/nyaa353

Publication Info

Adil, Syed M, Lefko T Charalambous, Charis A Spears, Musa Kiyani, Sarah E Hodges, Zidanyue Yang, Hui-Jie Lee, Shervin Rahimpour, et al. (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.

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