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.

Type

Journal article

Department

Description

Provenance

Subjects

Humans, Opioid-Related Disorders, Analgesics, Opioid, Retrospective Studies, Adult, Middle Aged, Female, Male, Pain Management, Chronic Pain, Spinal Cord Stimulation

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.

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.

Scholars@Duke

Yang

Lexie Zidanyue Yang

Biostatistician II

Education: Masters Degree, Biostatistics.  Duke University School of Medicine. 2018

Overview: Lexie graduated from the master’s program in biostatistics at Duke in 2018. Over the past five years, she has collaborated with doctors, residents, fellows, and medical students in the Department of Neurosurgery and Pharmacy. Additionally, she is currently working with a faculty member in Surgery to investigate the impact of environmental factors on certain diseases. Lexie has extensive experience in data management with large databases, including MarketScan, HCUP, and CMS Medicare. She has also worked with EHR data and has experience with data extraction from DEDUCE and CRDM. Her statistical interests include longitudinal analysis, mediation analysis, survival analysis and latent class analysis.

Educational Background
Master of Biostatistics
Duke University (Durham, NC, USA) 2016-2018

Bachelor of Science
Mathematics, Statistics
University of Wisconsin-Madison (Madison, WI, USA) 2013-2016
Shandong University (Shandong, China) 2011-2013


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