Does Neuromodulation Reduce Chronic Pain Patient Emergency Department Utilization?

Abstract

BACKGROUND:Chronic pain (CP) affects roughly 100 million adults in the United States. These subjects present disproportionately to the emergency department (ED). Neuromodulation (NM) has been shown to reduce ED visits longitudinally in subjects.OBJECTIVE:To compare ED utilization rates between subjects with CP with and without NM.METHODS:Subjects with failed back surgery syndrome, complex regional pain syndrome, or neuropathic pain diagnosis who visited the hospital between January 1, 2019, and December 31, 2019, were included. Subjects were divided into a NM-treated cohort and a non-NM cohort. Demographic information, medications, and pain provider visits were obtained. Pain-related ED visits between 2017 and 2019 were compared.RESULTS:A total of 2516 subjects were identified; 291 (11.6%) previously underwent NM. The non-NM cohort had significantly higher rate of pain-related ED visits compared with the NM cohort (15.1% vs 10.0%, P = .018). Younger age (odds ratio [OR] = 0.888 [0.843-0.935]), shorter distance to the hospital (OR = 0.807 [0.767-0.849]), lower household income (OR = 0.865 [0.831-0.901]), opioid use (OR = 1.375 [1.291-1.465]), nonopioid use (OR = 1.079 [1.033-1.128]), and non-NM therapy (OR = 1.751 [1.283-2.390]) were significant predictors of ED visits. Opioid use was the only significant predictor (OR = 6.124 [1.417-26.473]) associated with ED visits in the NM cohort.CONCLUSION:Subjects who underwent NM had fewer visits to the ED when compared with similar subjects who received conventional treatment. Opioid use prompted increased ED utilization in both cohorts. We posit that NM leads to improvement in pain outcomes, integration with multidisciplinary pain specialists, and reduction in severity and frequency of acute pain exacerbations, thereby limiting health care resource utilization.

Healthcare Utilization (HCU) Reduction with High-Frequency (10 kHz) Spinal Cord Stimulation (SCS) Therapy

“…Interestingly, Figueroa et al found certain factors that may predict a higher probability for CLBP subjects to seek ED services. These factors include younger age, lower income, near hospital housing, and opioid use at baseline; however, only opioid use was a significant predictor of seeking ED service in subjects with CLBP who underwent neuromodulation therapy [49].…”

Does Neuromodulation Reduce Chronic Pain Patient Emergency Department Utilization?: Corrigendum

“…In the article appearing in volume 90, pages 131-139 of Neurosurgery , entitled “Does Neuromodulation Reduce Chronic Pain Patient Emergency Department Utilization?,” there was an error. 1…”