Pain Catastrophizing Does Not Predict Spinal Cord Stimulation Outcomes: A Cohort Study of 259 Patients With Long-Term Follow-Up

Poulsen, Dennis Møgeltoft; Sørensen, Jens Christian; Blichfeldt-Eckhardt, Morten Rune; Gulisano, Helga Angela; Knudsen, Anne Lene; Nikolajsen, Lone; Meier, Kaare

doi:10.1111/ner.13213

Cited by 17 publications

(13 citation statements)

References 34 publications

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“…It is of note that previous studies, including a recent study from our own group (Poulsen et al., 2020), demonstrated no correlation between baseline PCS score and treatment outcomes, suggesting that a high baseline PCS score does not contraindicate SCS (Lamé et al., 2009; Poulsen et al., 2020).…”

Section: Discussionmentioning

confidence: 70%

Spinal cord stimulation in severe cases of complex regional pain syndrome: A retrospective cohort study with long‐term follow‐up

Eriksen

Terkelsen

Blichfeldt-Eckhardt

et al. 2021

European Journal of Pain

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Background Complex regional pain syndrome (CRPS) is a debilitating pain condition often resistant to standard treatment modalities. In these cases, spinal cord stimulation (SCS) can be an option, but the effect on CRPS remains disputed. We aimed to assess the long‐term effect of SCS on CRPS. Methods We retrospectively analysed 51 CRPS patients implanted with an SCS system at the University Hospitals in Aarhus or Odense, Denmark, with a median follow‐up time of 4.4 years. Primary outcomes were pain intensity on a numeric rating scale (NRS) and the Patients’ Global Impression of Change (PGIC). Secondary outcomes were patient satisfaction, work status, consumption of pain medication, the Major Depression Inventory (MDI), Pain Catastrophizing Scale (PCS) and quality of life (QoL) measured using the Short‐Form Health Survey (SF‐36). For each outcome measure, baseline data were compared to the latest collected data point. Results A significant pain relief was found with a mean reduction in NRS score of 2.4 (95% CI: 1.7–3.0, p < 0.0001). 68.8% reported ‘much improved’ or ‘very much improved’ on the PGIC scale. 87.5% would choose SCS again for the same outcome. A significant beneficial impact was found on MDI score, PCS, SF‐36 summary scores and consumption of tricyclic antidepressants, antiepileptic drugs and opioids. No statistical effect was found on work status. Conclusion Pain intensity, depression, pain catastrophizing, pain medication use and QoL were significantly improved after SCS implantation, with high patient satisfaction rates in CRPS patients. This study supports the continued use of SCS in the treatment of severe CRPS. Significance This study presents detailed data from a large, well‐characterized cohort of Danish CRPS patients treated with SCS, analyzing several outcome measures. The results serve to document SCS as an effective treatment for severe CRPS and expands the cumulative level of evidence in favor of its use. Additionally, analysis of preoperative patient characteristics suggests that SCS treatment should not be withheld in patients with a high degree of psychological distress or high consumption of analgesics.

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Section: Discussionmentioning

confidence: 70%

Spinal cord stimulation in severe cases of complex regional pain syndrome: A retrospective cohort study with long‐term follow‐up

Eriksen

Terkelsen

Blichfeldt-Eckhardt

et al. 2021

European Journal of Pain

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“…For example various psychological factors such as somatization, depression and anxiety, as well as older age and chronic pain duration, were found to correspond with poorer treatment outcomes (Campos et al, 2019; Celestin et al, 2009; Stephens & Ward, 2014). However, others reported a lack of predictive ability of psychological factors such as pain catastrophizing (Poulsen et al, 2021) or a more complex relationship between predictors and outcomes depending on their nature (Fama et al, 2016). Thus, patients' selection for SCS is a major, open issue that requires further examination.…”

Section: Discussionmentioning

confidence: 99%

Short‐ and long‐term effects of conventional spinal cord stimulation on chronic pain and health perceptions: A longitudinal controlled trial

Brill

Defrin

Aryeh

et al. 2022

European Journal of Pain

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Background The effectiveness and long‐term outcomes of spinal cord stimulation (SCS) are not fully established, especially considering that data from patients who withdrew from the trial are rarely analysed, which may lead to overestimation of SCS efficacy. We evaluated short‐ and long‐term effects of SCS on chronic pain and perceived health, beyond natural variability in these outcomes. Methods In a prospective design, 176 chronic pain patients referred to SCS were evaluated five times (baseline; retest ~6 weeks later; post‐SCS trial; 8 and 28 weeks post‐permanent implantation). Patients whose SCS trial failed (Temp group) were followed up and compared to those who underwent permanent SCS (Perm group). Results Analyses revealed a non‐linear (U‐shaped) trend significantly different between the two groups. In the Perm group, a significant improvement occurred post‐SCS implantation in pain severity, pain interference, health‐related quality of life and self‐rated health, which was followed by gradual worsening and return to baseline values at end of follow‐up. In the Temp group, only minor changes occurred in these outcomes over time. On average, baseline and end of follow‐up values in the Perm and Temp groups were similar: ~40% in each group exhibited an increase in pain severity over time and 38% and 33%, respectively, exhibited reductions in pain severity over time. Conclusions Since the greatest improvement in the outcome measures occurred from baseline to post‐SCS trial (T1–T3) followed by a gradual decline in the effect, it appears that SCS may not be effective for the majority of chronic pain patients. Significance This longitudinal study evaluated short and long term effects of spinal cord stimulation (SCS) on chronic pain outcome measures, beyond their natural variation in time. Despite significant short term improvements, by the end of the seven months' follow‐up, the outcomes in the treatment group (people who received the permanent implantation) were similar to those of the control group (people whose SCS trial failed and did not continue to permanent implantation) suggesting SCS may not be cost‐effective for chronic pain patients.

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“…In a recent retrospective cohort study performed at our center, 49 of 259 patients (18.9%) in a mixed population were women aged 18 to 45 years at the time of their SCS implantation. 6 Although pregnancy is an absolute contraindication to SCS implantation because of the use of fluoroscopy during the procedure, less is known about potential adverse effects of continued, active treatment on the unborn baby.…”

Section: Scs and Pregnancymentioning

confidence: 99%

Burst Spinal Cord Stimulation in Pregnancy: First Clinical Experiences

Meier

Glavind

Milidou

et al. 2023

Neuromodulation: Technology at the Neural Interface

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Pain Catastrophizing Does Not Predict Spinal Cord Stimulation Outcomes: A Cohort Study of 259 Patients With Long-Term Follow-Up

Cited by 17 publications

References 34 publications

Spinal cord stimulation in severe cases of complex regional pain syndrome: A retrospective cohort study with long‐term follow‐up

Spinal cord stimulation in severe cases of complex regional pain syndrome: A retrospective cohort study with long‐term follow‐up

Short‐ and long‐term effects of conventional spinal cord stimulation on chronic pain and health perceptions: A longitudinal controlled trial

Burst Spinal Cord Stimulation in Pregnancy: First Clinical Experiences

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