Racial and Socioeconomic Disparities in Spinal Cord Stimulation Among the Medicare Population

Jones, Mark R.; Orhurhu, Vwaire; O’Gara, Brian; Brovman, Ethan Y.; Rao, Nikhilesh; Vanterpool, Stephanie; Poree, Lawrence; Gulati, Amitabh; Urman, Richard D.

doi:10.1111/ner.13373

Cited by 16 publications

(7 citation statements)

References 29 publications

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“…Providing this option gives the patient an opportunity to avoid the need for a permanently implanted system or surgery prematurely or altogether in chronic back pain. PNS shows promise to function as an early and effective option in the treatment continuum while reducing pain, opioid use, and disability [ 35 , 38 ].…”

Section: Peripheral Nerve Stimulation For Back Painmentioning

confidence: 99%

Peripheral Nerve Stimulation: A Review of Techniques and Clinical Efficacy

et al. 2021

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Chronic pain is a common source of morbidity in many patient populations worldwide. There are growing concerns about the potential side effects of currently prescribed medications and a continued need for effective treatment. Related to these concerns, peripheral nerve stimulation has been regaining popularity as a potential treatment modality. Peripheral nerve stimulation components include helically coiled electrical leads, which direct an applied current to afferent neurons providing sensory innervation to the painful area. In theory, the applied current to the peripheral nerve will alter the large-diameter myelinated afferent nerve fibers, which interfere with the central processing of pain signals through small-diameter afferent fibers at the level of the spinal cord. Multiple studies have shown success in the use of peripheral nerve stimulation for acute postsurgical pain for orthopedic surgery, including post total knee arthroplasty and anterior cruci-

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Section: Peripheral Nerve Stimulation For Back Painmentioning

confidence: 99%

Peripheral Nerve Stimulation: A Review of Techniques and Clinical Efficacy

et al. 2021

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“…Although black patients represent ~7.2% of senior enrollees in fee-for-service,56 they comprised only 4.8% of duloxetine users (vs 7.8% of gabapentin users) in this cohort. These rates may reflect a larger trend of disparate treatment (including treatment of chronic pain) among black patients in the United States7,57–60 and/or be more reflective of socioeconomic factors, rather than characteristics attributable specifically to race. Second, despite a careful selection of more than 300 covariates, there is still the potential for unmeasured confounders, particularly for factors such as smoking and obesity.…”

Section: Discussionmentioning

confidence: 99%

Duloxetine, Gabapentin, and the Risk for Acute Myocardial Infarction, Stroke, and Out-of-Hospital Death in Medicare Beneficiaries With Non-Cancer Pain

Corriere¹,

Dickson²,

Daniel

et al. 2023

The Clinical Journal of Pain

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Objective: Duloxetine is a serotonin-norepinephrine reuptake inhibitor prescribed for musculoskeletal and other forms of chronic pain. Its dual pharmacologic properties have the potential to either raise or lower cardiovascular risk: adrenergic activity may increase the risk for acute myocardial infarction (AMI) and stroke, but antiplatelet activity may decrease risk. Gabapentin is another nonopioid medication used to treat pain, which is not thought to have adrenergic/antiplatelet effects. With the current emphasis on the use of nonopioid medications to treat patients with chronic pain, assessing cardiovascular risks associated with these medications among high-risk patients is important. Materials and Methods: We conducted a retrospective cohort study among a 20% sample of Medicare enrollees, aged 65 to 89, with chronic pain who were new users between 2015 and 2018 of either duloxetine (n = 34,009) or gabapentin (n = 233,060). We excluded individuals with cancer or other life-threatening conditions at study drug initiation. The primary outcome was a composite of AMI, stroke, and out-of-hospital mortality. We adjusted for comorbidity differences with time-dependent inverse probability of treatment weighting. Results: During 115,668 person-years of follow-up, 2361 patients had the composite primary outcome; the rate among new users of duloxetine was 16.7/1000 person-years compared with new users of gabapentin (21.1/1000 person-years), adjusted hazard ratio = 0.98 (95% CI: 0.83, 1.16). Results were similar for the individual components of the composite outcome as well as in analyses stratified by demographic and clinical characteristics. Discussion: In summary, cohort Medicare patients with non-cancer pain beginning treatment with duloxetine had rates of AMI, stroke, and out-of-hospital mortality comparable to those who initiated gabapentin.

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“…Health disparities are well‐known across specialties, and even in systems that provide unencumbered access to healthcare, such as VA healthcare system, studies suggest factors other than access to care are responsible for this disparity 24 . A previous study which employed similar methodology examined the utilization of spinal cord stimulation in the Medicare population and demonstrated that Medicare/Medicaid dual‐eligible and minority patients were significantly less likely to receive spinal cord stimulators than White patients with Medicare 9 . Similarly, ethnicity and socioeconomic status (SES) can significantly impact the level of treatment of an individual's pain 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Depression, anxiety, nicotine dependence, substance abuse, immunodeficient status, personal history of immunosuppression therapy, obesity, and diabetes mellitus were also included as covariates in our analysis due to reported associations with increased risk of developing chronic pain, increased severity of chronic pain syndromes, or negative prognostic value on interventional pain treatments 19–21 . Contraindications for kyphoplasty including coagulation defects (i.e., hereditary factor VIII deficiency and hereditary factor IX deficiency), hemorrhagic/purpuric conditions, patients on long‐term (current) use of anticoagulants and antithrombotic/antiplatelet therapy as well as those with a radiographic dye allergy were excluded 9,22 …”

Section: Methodsmentioning

confidence: 99%

“…Ethnicity and socioeconomic status (SES) have been shown to significantly impact the quality of care administered to patients seeking care for management of chronic pain. 9 Racial minorities are frequently undertreated and report experiencing greater burdens of pain. Research has shown inequities in the quality of healthcare have a multitude of contributing factors.…”

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Racial and socioeconomic disparities in kyphoplasty among the Medicare population

Krishnan,

Brovman,

Jones

et al. 2023

Pain Practice

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IntroductionKyphoplasty is a minimally invasive treatment for chronic refractory pain secondary to spinal compression fracture. This study investigates racial and socioeconomic disparities in kyphoplasty among the Medicare population.Materials and MethodsThis study utilized data from the Medicare Limited Data Sets (LDS), a CMS administrative claims database. Patients aged 18 and older with ICD code consistent with spinal pathology and compression fractures were included. Outcome was defined as kyphoplasty by race and socioeconomic status (SES) with low SES defined by dual enrollment in Medicare/Medicaid.ResultsThere was a total of 215,502 patients gathered from CMS data, and 717 (0.33%) of these patients underwent kyphoplasty during the study period. Of these patients, 458 (63.8%) were female, the average age was 76.5 years old, 655 (91.3%) were White, 20 (2.7%) were Black, 9 (1.3%) were Hispanic, and 98 (13.7%) were Medicare/Medicaid dual eligible. White patients (32,317/157,177 [20.6%]) were less likely to be dual enrollment eligible in Medicare and Medicaid than Black (5407/13,522 [39.9%]), Hispanic (2833/3675 [77.1%]), Asian (2087/3312 [63.0%]), or North American Native patients (778/1578 [49.1%]). Multivariate regression (MVR) analysis was performed and showed that Blacks were less likely than Whites to have a kyphoplasty performed (OR 0.46 [95% CI: 0.29–0.72], p‐value <0.001). Although Hispanics (OR 0.95 [0.49–1.86]), North American Native (OR 0.82 [0.3–2.19]), and unknown race had a decreased odd of undergoing kyphoplasty, it was not statistically significant.ConclusionOur study showed after adjustment for pertinent comorbidities, Medicare/Medicaid dual‐eligible patients and Black patients were significantly less likely to receive kyphoplasty than White patients with Medicare.

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Racial and Socioeconomic Disparities in Spinal Cord Stimulation Among the Medicare Population

Cited by 16 publications

References 29 publications

Peripheral Nerve Stimulation: A Review of Techniques and Clinical Efficacy

Peripheral Nerve Stimulation: A Review of Techniques and Clinical Efficacy

Duloxetine, Gabapentin, and the Risk for Acute Myocardial Infarction, Stroke, and Out-of-Hospital Death in Medicare Beneficiaries With Non-Cancer Pain

Racial and socioeconomic disparities in kyphoplasty among the Medicare population

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