Discontinuation of Chronic Opiate Therapy After Successful Spinal Cord Stimulation Is Highly Dependent Upon the Daily Opioid Dose

Abstract

Objectives The aim of this study was to determine if any of the factors recorded on a standard clinical history of a patient considered for spinal cord stimulation (SCS) would be associated with reduction or cessation of opioids following implantation. Design Retrospective, single academic center. Methods Patients included in the chart analysis underwent implantation of percutaneous SCS devices from 1999 to 2015 with follow‐up until the end of September 2018. Patients who achieved at least an average of 50% pain reduction were included for analysis of daily opioid intake. Patients were then divided into 4 groups that included no opioid use, stable opioid daily dose, weaned opioid dose, and complete cessation of opioids. Statistical methods were used to analyze for associations between opioid intake after SCS insertion and usual elements of a clinical history, including adjuvant medications, numeric pain rating, past medical history, psychiatric illness, substance abuse, employment, and smoking history. Results In a group of 261 patients who had undergone implantation, 214 met the criteria for analysis and had a median age of 50 years, with majority having the diagnoses of failed back surgery syndrome and complex regional pain syndrome. The only factor that was associated with complete cessation of opioid use was a median dose of 30 mg of morphine per day (P < 0.01) and was observed in 15% of subjects who used opioids preoperatively. Conclusion The elimination of opioid dependence following initiation of SCS therapy is highly dependent on the daily dose.

Randomized Prospective Study in Patients With Complex Regional Pain Syndrome of the Upper Limb With High-Frequency Spinal Cord Stimulation (10-kHz) and Low-Frequency Spinal Cord Stimulation

“…The conventional treatments used in this type of patients may not only not reduce the symptoms completely but can also entail side effects and restrictions in the daily life of the patients. Patients treated conventionally, may require interventional treatments that allow for the reduction of medication prescribed, such as SCS, a therapy that masks pain signals before they reach the brain (30,33).…”

Pain Relief and Opioid Usage in Upper Limb and Neck Pain Patients After 10-kHz Spinal Cord Stimulation Treatment: Subanalysis of USA Studies

“…A recent retrospective analysis of insurance claim data in patients who were chronic opioid users before receiving conventional SCS showed that daily opioid doses of less than 65 MME at the start of SCS treatment were predictive of reduced opioid use in response to stimulation therapy [27]. A single-center retrospective study of patients who received low-frequency SCS for refractory neuropathic pain similarly reported that baseline opioid use of ≤30 MME daily was predictive of opioid cessation and that most responders (≥50% pain relief ) did not reduce opioid use over the course of the study [28]. Likewise, a retrospective study in over 631 patients who received intrathecal drug administration for chronic, noncancer pain also found that baseline systemic opioid dose was strongly correlated with whether patients would discontinue opioid use during the following year, with those taking less than 50 MME being twofold more likely to stop opioid use than those taking 90 MME or more [29].…”

Opioid‐sparing effects of 10 kHz spinal cord stimulation: a review of clinical evidence

“…32 Although these studies have been primarily focused on the outcome of pain reduction and responder rate, defined as the proportion of patients who experience at least 50% pain reduction without any neurologic deficits, many include assessments of pain medication use among reported secondary outcomes. Conventional SCS treatment has been shown to be associated with reduction in conventional opioid dose and stabilization of usage in two large retrospective studies by Sharan et al and Simopoulos et al 33,34 Multiple systematic reviews also demonstrated increased odds of reducing pain medication in patients with intractable pain follow-ing SCS treatment. 35,36 Considering the potential advantages of 10 kHz SCS, this review was conducted to summarize the current landscape of evidence in the medical literature regarding the efficacy of 10 kHz SCS to both treat pain symptoms and reduce the amount of conventional opioid analgesics required by patients with chronic, noncancer pain.…”

“…Conventional SCS treatment has been shown to be associated with reduction in conventional opioid dose and stabilization of usage in two large retrospective studies by Sharan et al . and Simopoulos et al . Multiple systematic reviews also demonstrated increased odds of reducing pain medication in patients with intractable pain following SCS treatment .…”