Determining the Minimal Clinical Important Difference for Medication Quantification Scale III and Morphine Milligram Equivalents in Patients with Failed Back Surgery Syndrome

Abstract

The Medication Quantification Scale III (MQS) is a tool to represent the negative impact of medication. A reduction in medication can serve as an indicator to evaluate treatment success. However, no cut-off value has yet been determined to evaluate whether a decrease in medication is clinically relevant. Therefore, the objective is to estimate the thresholds for the MQS and morphine milligram equivalents (MMEs) that best identify a clinically relevant important improvement for patients. Data from the Discover registry, in which patients with failed back surgery syndrome were treated with high-dose spinal cord stimulation, were used. Patient satisfaction was utilized to evaluate a clinically important outcome 12 months after stimulation. Anchor-based and distribution-based methods were applied to determine the minimal clinical important difference (MCID). Distribution-based methods revealed a value of 4.28 for the MQS and 33.61 for the MME as MCID. Anchor-based methods indicated a percentage change score of 41.2% for the MQS and 28.2% for the MME or an absolute change score of 4.72 for the MQS and 22.65 for the MME. For assessing a treatment outcome, we recommend using the percentage change score, which better reflects a clinically important outcome and is not severely influenced by high medication intake at baseline.

Predicting the Response of High Frequency Spinal Cord Stimulation in Patients with Failed Back Surgery Syndrome: A Retrospective Study with Machine Learning Techniques

“…Another important issue in light of the ongoing opioid epidemic is the reduction in medication use. Therefore, a third definition of responder was created based on reaching the minimal clinical important difference of the MQS [ 23 ]. With this outcome, logistic regression and LDA resulted in an accuracy of more than 80% on the validation set.…”

“…Additionally, the outcome variable was also defined as a patient who has 30% pain relief, which is in line with the minimal clinical important difference for pain intensity [ 22 ]. Finally, the outcome variable was also defined as a patient who has at least 41.2% reduction in pain medication use, which is in line with the minimal clinical important difference for medication use in this population [ 23 ].…”

Medical Cannabis Use Reduces Opioid Prescriptions in Patients With Chronic Back Pain

“…A 28.2% change in MME/day has been suggested as a minimal clinical important difference (MCID) [19]. Based on our data, MME/day dropped 27.0%, 39.4%, and 24.5% in all patients, patients below 15 MME/day, and patients above 15 MME/day, respectively.…”

Medical Cannabis Use Reduces Opioid Prescriptions in Patients With Osteoarthritis

“…A 28.2% change in MME/day has been suggested as a minimal clinical important difference (MCID) [ 15 ]. Based on our data, MME/day dropped at a level that would meet the criteria for MCID.…”