The impact of obesity on the effectiveness of spinal cord stimulation in chronic spine-related pain patients

Mekhail, Nagy; Mehanny, Diana Sue; Armanyous, Sherif; Saweris, Youssef; Costandi, Shrif

doi:10.1016/j.spinee.2018.08.006

Cited by 24 publications

(24 citation statements)

References 27 publications

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“…Interestingly, treatment parameters such as SCS waveform correlated with successful trials. Our finding that pain location is significant echoes prior reports (16)(17)(18) that support the superior efficacy of SCS for lower extremity pain. In contrast to previous findings, however, pain symptoms such as allodynia or hyperalgesia were not relevant factors; neither were neuropathic vs nociceptive pain (15,(19)(20).…”

Section: Discussionsupporting

confidence: 87%

“…Primary pain site was a significant factor (P = .032), with the lower extremity being the most frequent location of pain among successful subjects (86%). Some factors not previously reported in the literature were found to be significant (16); the stimulator waveform was strongly associated with a successful trial (P = .003), with the paresthesia based (PB) tonic waveform being most frequently associated with a positive outcome (46.4%), followed by burst (33.8%), and then the paresthesia free (PF) high frequency waveform (11.3%). Patients had similar pain scores across the board before initiating an SCS trial (mean pain score 8 out of 10).…”

Section: Resultsmentioning

confidence: 84%

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Fantastic Four: Age, Spinal Cord Stimulator Waveform, Pain Localization and History of Spine Surgery Influence the Odds of Successful Spinal Cord Stimulator Trial

et al. 2020

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Background: There is a dearth in our understanding of the factors that are predictive of successful spinal cord stimulator (SCS) trials and eventual conversion to permanent implants. Knowledge of these factors is important for appropriate patient selection and treatment optimization. Objectives: Although previous studies have explored factors predictive of trial success, few have examined the role of waveform in trial outcomes. This study sought to establish the relationship of neuraxial waveform and related measures to trial outcomes. Study Design: This study used a retrospective chart review design. Methods: Data were retrospectively collected on 174 patients undergoing SCS trials upon institutional review board approval of the study protocol. Indications for SCS were: complex regional pain syndrome, failed back surgery syndrome with radicular symptoms, peripheral neuropathy, and axial low back pain. Descriptive statistics and logistic regression analyses were used to assess the association of demographic and clinical variables with SCS trial outcomes. Results: The study population comprised 56% women, had a median age of 55 (interquartile range [IQR], 44-64), and 32 of 174 (18%) patients failed SCS trials. Individuals with successful trials (≥ 50% pain relief) were significantly younger and had a median age of 54 years (IQR, 42-60) compared to those who failed SCS trials (median age 66 years; IQR, 50-76; P = .005). Adjusting for age, gender, number of leads, pain category, and diagnoses: surgical history (odds ratio [OR] = 4.4; 95% confidence interval [CI], 1.3-15.8) and paresthesia-based tonic-stimulation (OR = 10.3; 95% CI, 1.7-62.0), but not burst or high frequency, were significantly associated with successful trials. Of note, the number of leads (whether dual or single), pain duration, characteristics, and category (nociceptive vs neuropathic) were not significant factors. An interaction between surgical spine history and lower extremity pain was significantly associated with a positive trial (P = .005). Limitations: This study was limited by its retrospective nature and focus on a patient population at a single major academic medical center. Conclusions: Paresthesia-based tonic stimulation, age, and surgical history have significant effects on SCS trials. Prospective and randomized controlled studies may provide deeper insights regarding impact on costs and overall outcomes. IRB Approval #: 2018P002216 Keywords: Pain duration, pain location, spinal cord stimulator trial, stimulator waveform, surgical history

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Section: Discussionsupporting

confidence: 87%

Section: Resultsmentioning

confidence: 84%

Fantastic Four: Age, Spinal Cord Stimulator Waveform, Pain Localization and History of Spine Surgery Influence the Odds of Successful Spinal Cord Stimulator Trial

et al. 2020

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“…In addition to obesity-induced disorders, clinical evidence suggests that pain conditions development in obese subjects, such as low back pain [46][47][48][49][50][51][52][53][54][55][56], musculoskeletal pain [57][58][59][60][61][62][63], osteoarthritis pain [64][65][66], knee pain [67][68][69][70], hip pain [71], foot pain [72], spine-related pain [73], migraine and/or headache [74][75][76][77][78][79][80], orofacial pain [81,82], and postsurgical pain [83]. Research shows that physical exercise may relieve obesity-induced pain in affected subjects [84][85][86][87][88][89].…”

Section: Introductionmentioning

confidence: 99%

Physiological Changes and Pathological Pain Associated with Sedentary Lifestyle-Induced Body Systems Fat Accumulation and Their Modulation by Physical Exercise

Verdú

Homs

Boadas-Vaello

2021

IJERPH

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A sedentary lifestyle is associated with overweight/obesity, which involves excessive fat body accumulation, triggering structural and functional changes in tissues, organs, and body systems. Research shows that this fat accumulation is responsible for several comorbidities, including cardiovascular, gastrointestinal, and metabolic dysfunctions, as well as pathological pain behaviors. These health concerns are related to the crosstalk between adipose tissue and body systems, leading to pathophysiological changes to the latter. To deal with these health issues, it has been suggested that physical exercise may reverse part of these obesity-related pathologies by modulating the cross talk between the adipose tissue and body systems. In this context, this review was carried out to provide knowledge about (i) the structural and functional changes in tissues, organs, and body systems from accumulation of fat in obesity, emphasizing the crosstalk between fat and body tissues; (ii) the crosstalk between fat and body tissues triggering pain; and (iii) the effects of physical exercise on body tissues and organs in obese and non-obese subjects, and their impact on pathological pain. This information may help one to better understand this crosstalk and the factors involved, and it could be useful in designing more specific training interventions (according to the nature of the comorbidity).

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“…It should be noted that a large number of patients who end up with an SCS system suffer from FBSS, which is exacerbated by obesity. However, only a few studies have addressed this particular issue (Marola et al., 2017; Mekhail et al., 2019). Finally, the relationship between male gender and lower success rate of HF10‐SCS therapy lacks a clear explanation and should not be overstated considering the potential bias related to the small sample size, although there are some studies with a higher sample size that show similar trends (Bir et al., 2016).…”

Section: Discussionmentioning

confidence: 99%

High‐frequency spinal cord stimulation as rescue therapy for chronic pain patients with failure of conventional spinal cord stimulation

Tous

Corral

García

et al. 2021

European Journal of Pain

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Background: This study aims to evaluate the efficacy of 10-kHz high-frequency (HF10) devices as a rescue treatment in patients with failure of conventional spinal cord stimulation (SCS) therapy for chronic pain without the need to change the spinal hardware. Methods: In this real-world prospective study, patients with neuropathic pain treated with conventional tonic SCS in whom the therapy had failed, either during the trial phase or after a period of optimal functioning, were recruited throughout 2 years for HF10-SCS therapy. Data on analgesia, functionality, analgesics use and treatment safety were collected 12 months after treatment. Results: Eleven of the 18 (61%) patients included in the study were successfully rescued with HF10-SCS. Of them, 5 out of 12 (45%) were in the trial phase and six out of six (100%) had previously functioning implants. A significant improvement in low-back and limb pain was obtained (p = 0.003 and p = 0.0001, respectively).Treatment success was significantly associated with gender (p = 0.037), weight (p = 0.014), body mass index (BMI) (p = 0.007) and time of rescue (p = 0.015). A linear regression test confirmed a significant association between treatment failure and BMI and gender (p = 0.004). Conclusions: Our results suggest that analgesic rescue with HF10-SCS is an effective therapeutic option for non-responders to conventional SCS, although obesity might be a limiting factor for treatment success. Nevertheless, more comprehensive studies are needed to corroborate our findings. Significance: This study shows that high-frequency stimulation may be useful in patients with failure of conventional tonic stimulation for chronic pain, both in the trial phase and in previously implanted subjects. The novelty of this study lies in the use of the implanted epidural electrodes, which avoids the need for further surgery.The results in terms of pain control and recovery of functionality are satisfactory. In addition, variables such as male gender and high body mass index could be predictors of therapy failure.

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The impact of obesity on the effectiveness of spinal cord stimulation in chronic spine-related pain patients

Cited by 24 publications

References 27 publications

Fantastic Four: Age, Spinal Cord Stimulator Waveform, Pain Localization and History of Spine Surgery Influence the Odds of Successful Spinal Cord Stimulator Trial

Fantastic Four: Age, Spinal Cord Stimulator Waveform, Pain Localization and History of Spine Surgery Influence the Odds of Successful Spinal Cord Stimulator Trial

Physiological Changes and Pathological Pain Associated with Sedentary Lifestyle-Induced Body Systems Fat Accumulation and Their Modulation by Physical Exercise

High‐frequency spinal cord stimulation as rescue therapy for chronic pain patients with failure of conventional spinal cord stimulation

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