Opioids and Spinal Cord Stimulators: Pre- and Postoperative Opioid Use Patterns and Predictors of Prolonged Postoperative Opioid Use

Abstract

The aim of the study was to compare trends and differences in preoperative and prolonged postoperative opioid use following spinal cord stimulator (SCS) implantation and to determine factors associated with prolonged postoperative opioid use. Methods: A database of private-payer insurance records was queried to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-C3655) from 2008-2015. Our resulting cohort was stratified into those with prolonged postoperative opioid use, opioid use between 3-and 6-month postoperation, and those without. Multivariate logistic regression was used to determine the effect preoperative opioid use and other factors of interest had on prolonged postoperative opioid use. Subgroup analysis was performed on preoperative opioid users to further quantify the effect of differing magnitudes of preoperative opioid use. Results: A total of 2,374 patients who underwent SCS placement were identified. Of all patients, 1,890 patients (79.6%) were identified as having prolonged narcotic use. Annual rates of preoperative (p = 0.023) and prolonged postoperative narcotic use (p < 0.001) decreased over the study period. Significant independent predictors of prolonged postoperative opioid use were age < 65 years (odds ratio [OR], 1.52; p = 0.004), male sex (OR, 1.33; p = 0.037), preoperative anxiolytic (OR, 1.55; p = 0.004) and muscle relaxant (OR, 1.42; p = 0.033), and narcotic use (OR, 15.04; p < 0.001). Increased number of preoperative narcotic prescriptions correlated with increased odds of prolonged postoperative use. Conclusion: Patients with greater number of preoperative opioid prescriptions may not attain the same benefit from SCSs as patients with less opioid use. The most significant predictor of prolonged narcotic use was preoperative opioid use.

Effect of Patient Characteristics on Clinical Outcomes More Than 12 Months Following Dorsal Root Ganglion Stimulation Implantation: A Retrospective Review

“…In this retrospective analysis, at nearly all time points and for both “responder” status thresholds, a history of chronic opioid use at the time of implant was associated with a statistically significant likelihood of “nonresponder” status. This is concordant with prior studies in neuromodulation, demonstrating that prior pre‐procedural opioid use generally correlated with worse clinical efficacy outcomes (26,27). This association also transcends to the chronic pain population undergoing other interventional procedures that does not involve neuromodulation (23).…”

A Call to Action Toward Optimizing the Electrical Dose Received by Neural Targets in Spinal Cord Stimulation Therapy for Neuropathic Pain

“…Importantly, SCS can reduce pain severity sufficiently to allow some pain patients to reduce their use of medications and break free of opioid dependence. 8,9 A landmark randomized controlled trial comparing SCS with conventional medical management showed that the former provided better leg pain relief, quality of life, and functional capacity and could be sustained through 24 months. 10 In the last decade, innovations in SCS have led to the development of new electrical waveforms.…”

Association of Spinal Cord Stimulator Implantation With Persistent Opioid Use in Patients With Postlaminectomy Syndrome

“…However, they are more favorable than a database review involving 2374 patients who underwent SCS paddle lead placement for a variety of different indications including PLS, radiculopathy, and lumbago, that actually reported an increase in post-implant opioid consumption in 5 of the 8 years analyzed (with no statistical difference in the other 3 years). 20 In this study, no pain comorbidity was significantly associated with a greater likelihood of reducing opioid consumption, and the criteria for defining preand postsurgical opioid consumption were more liberal than ours. It is important to note that there are no clinical trials evaluating pure mu opioid agonists for PLS in a nonaddicted population, and that opioids may exacerbate central sensitization in those who fail spine surgery with nociplastic, nonspecific spinal pain.…”