High‐Dose Spinal Cord Stimulation Reduces Long‐Term Pain Medication Use in Patients With Failed Back Surgery Syndrome Who Obtained at Least 50% Pain Intensity and Medication Reduction During a Trial Period: A Registry‐Based Cohort Study. Issue 3 (20th January 2021)

• Record Type: Journal Article
• Authors: Goudman, Lisa; De Smedt, Ann; Forget, Patrice; Eldabe, Sam; Moens, Maarten
• Is Part Of: Neuromodulaton. Volume 24:Issue 3(2021)
• Page Start: 520
• Page End: 531
• Publication Date: 2021-01-20
• Subjects: High‐dose spinal cord stimulation -- medication -- opioids -- registry‐based cohort study; Central nervous system -- Physiology -- Periodicals; Central nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ner.13363
• Languages: English
• ISSNs: 1094-7159

Abstract

Abstract: Objectives: High‐dose spinal cord stimulation (HD‐SCS) revealed positive results for obtaining pain relief in patients with failed back surgery syndrome (FBSS). However, it is less clear whether HD‐SCS also is able to reduce pain medication use. The aim of this registry‐based cohort study is to explore the impact of HD‐SCS on pain medication use in FBSS patients. Materials and Methods: Data from the Discover registry was used in which the effectiveness of HD‐SCS was explored in neurostimulation‐naïve FBSS patients as well as in rescue patients. All neurostimulation‐naïve FBSS patients positively responded to a four‐week SCS trial period in which at least 50% pain relief and 50% medication reduction were obtained. Medication use was measured with the Medication Quantification Scale III (MQS) in 259 patients at baseline and at 1, 3, and 12 months of HD‐SCS. Additionally, defined daily doses (DDD) and morphine milligram equivalents (MME) were calculated as well. Results: One hundred thirty patients reached the visit at 12 months. In neurostimulation‐naïve patients, a statistically significant decrease in MQS (χ 2 = 62.92, p < 0.001), DDD (χ 2 = 11.47, p = 0.009), and MME (χ 2 = 21.55, p < 0.001) was found. In rescue patients, no statistically significant improvements were found. In both patient groups, statistically significant reductions in the proportion of patients on high‐risk MME doses ≥90 were found over time. At the intraindividual level, positive correlations were found between MSQ scores and pain intensity for back ( r = 0.56, r = 0.31, p < 0.001) and leg pain ( r = 0.61, r = 0.22, p < 0.001) in neurostimulation‐naïve and rescue patients, respectively. Conclusions: Registry data on HD‐SCS in FBSS patients revealed a statistically significant and sustained decrease in pain medication use, not only on opioids, but also on anti‐neuropathic agents in neurostimulation‐naïve patients, who positively responded to an SCS trial period with at least 50% pain relief and 50% pain medication decrease, but not in rescue patients.