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The Clinical journal of pain
02 07, 2022;38 (4): 285-291.

The Role of Spinal Cord Stimulation in Reducing Opioid Use in the Setting of Chronic Neuropathic Pain: A Systematic Review.

Cynthia A Smith, Jessica Roman, Antonios Mammis
Author Information
  1. Cynthia A Smith: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ.
  2. Jessica Roman: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ.
  3. Antonios Mammis: Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY.
PMID: 35132028 DOI: 10.1097/AJP.0000000000001021

Abstract

OBJECTIVE: The aim was to examine research on the impact of spinal cord stimulation (SCS) on the reduction of preimplantation opioid dose and what preimplantation opioid dose is associated with a reduction or discontinuation of opioid use postimplantation.
METHODS: Systematic review of literature from PubMed, Web of Science, and Ovid Medline search of "opioid" and "pain" and "spinal cord stimulator." Inclusion criteria included original research providing data on SCS preimplantation opioid dosing and 12 months postimplantation opioid dosing or that correlated specific preimplantation opioid dose or opioid dose cutoff with significantly increased likelihood of opioid use discontinuation at 12 months postimplantation.
RESULTS: Systematic review of the literature yielded 17 studies providing data on pre-SCS and post-SCS implantation dose and 4 providing data on the preimplantation opioid dose that significantly increased likelihood of opioid use discontinuation at 12 months postimplantation. Data from included studies indicated that SCS is an effective tool in reducing opioid dose from preimplantation levels at 12 months postimplantation. Data preliminarily supports the assertion that initiation of SCS at a preimplantation opioid dose of ≤20 to ≤42.5 morphine milligram equivalents increases the likelihood of postimplantation elimination of opioid use.
DISCUSSION: SCS is an effective treatment for many types of chronic pain and can reduce or eliminate chronic opioid use. Preimplantation opioid dose may impact discontinuation of opioid use postimplantation and the effectiveness of SCS in the relief of chronic pain. More research is needed to support and strengthen clinical recommendations for initiation of SCS use at lower daily opioid dose.

References

Dahlhamer J, Lucas C, Zelaya C, et al. Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67:1001–1006.
Murphy KR, Han JL, Yang S, et al. Prevalence of specific types of pain diagnoses in a sample of United States Adults. Pain Physician. 2017;20:E257–E268.
Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 1986;3:S1–S226.
Els C, Jackson TD, Hagtvedt R, et al. High-dose opioids for chronic non-cancer pain: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;10:CD012299.
Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicenter randomized controlled trial in patients with failed back surgery syndrome. Pain. 2007;132:179–188.
Nijs J, Apeldoorn A, Hallegraeff H, et al. Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain. Pain Physician. 2015;18:E333–E346.
Ballantyne JC, Kalso E, Stannard C. WHO analgesic ladder: a good concept gone astray. BMJ. 2016;352:i20.
Yang J, Bauer BA, Wahner-Roedler DL, et al. The modified WHO analgesic ladder: is it appropriate for chronic non-cancer pain? JPain Res. 2020;13:411–417.
Sharan AD, Riley J, Falowski S, et al. Association of opioid usage with spinal cord stimulation outcomes. Pain Med. 2018;19:699–707.
Kapural L, Yu C, Doust MW, et al. Novel 10-kHz high-frequency therapy (HF10 therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: The SENZA-RCT Randomized Controlled Trial. Anesthesiology. 2015;123:851–60.
Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA. 2016;315:1624–1645.
Lawrence L. Viewpoint: from ladder to platform: a new concept for pain management. J Prim Health Care. 2012;4:254–258.
Cuomo A, Bimonte S, Forte CA, et al. Multimodal approaches and tailored therapies for pain management: the trolley analgesic model. J Pain Res. 2019;12:711–714.
Sanders RA, Moeschler SM, Gazelka HM, et al. Patient outcomes and spinal cord stimulation: a retrospective case series evaluating patient satisfaction, pain scores, and opioid requirements. Pain Pract. 2016;16:899–904.
Levine AB, Parrent AG, MacDougall KW. Cervical spinal cord and dorsal nerve root stimulation for neuropathic upper limb pain. Can J Neurol Sci. 2017;44:83–89.
Levine AB, Parrent AG, MacDougall KW. Stimulation of the spinal cord and dorsal nerve roots for chronic groin, pelvic, and abdominal pain. Pain Physician. 2016;19:405–412.
Al-Kaisy A, Palmisani S, Smith TE, et al. 10 kHz high-frequency spinal cord stimulation for chronic axial low back pain in patients with no history of spinal surgery: a preliminary, prospective, open label and proof-of-concept study. Neuromodulation. 2017;20:63–70.
DiBenedetto DJ, Wawrzyniak KM, Schatman ME, et al. 10 kHz spinal cord stimulation: a retrospective analysis of real-world data from a community-based, interdisciplinary pain facility. J Pain Res. 2018;11:2929–2941.
Dougherty MC, Woodroffe RW, Wilson S, et al. Predictors of reduced opioid use with spinal cord stimulation in patients with chronic opioid use. Neuromodulation. 2020;23:126–132.
Kapural L, Sayed D, Kim B, et al. Retrospective assessment of salvage to 10 kHz spinal cord stimulation (SCS) in patients who failed traditional SCS therapy: RESCUE study. J Pain Res. 2020;13:2861–2867.
Russo M, Brooker C, Cousins MJ, et al. Sustained long-term outcomes with closed-loop spinal cord stimulation: 12-month results of the prospective, multicenter, open-label avalon study. Neurosurgery. 2020;87:E485–E495.
D’Souza RS, Strand N. Neuromodulation with burst and tonic stimulation decreases opioid consumption: a post hoc analysis of the success using neuromodulation with BURST (SUNBURST) randomized controlled trial. Neuromodulation. 2021;24:135–141.
Al-Kaisy A, Van Buyten JP, Kapural L, et al. 10 kHz spinal cord stimulation for the treatment of non-surgical refractory back pain: subanalysis of pooled data from two prospective studies. Anaesthesia. 2020;75:775–784.
Baranidharan G, Feltbower R, Bretherton B, et al. One-year results of prospective research study using 10 kHz spinal cord stimulation in persistent nonoperated low back pain of neuropathic origin: maiden back study. Neuromodulation. 2021;24:479–487.
Barpujari A, Erdek MA. Retrospective analysis on the effect of spinal cord stimulation on opioid consumption. Pain Manag. 2021;11:123–132.
Amirdelfan K, Vallejo R, Benyamin R, et al. High-frequency spinal cord stimulation at 10 kHz for the treatment of combined neck and arm pain: results from a prospective multicenter study. Neurosurgery. 2020;87:176–185.
Adil SM, Charalambous LT, Spears CA, et al. Impact of spinal cord stimulation on opioid dose reduction: a nationwide analysis. Neurosurgery. 2020;88:193–201.
Amirdelfan K, Vallejo R, Benyamin R, et al. Pain relief and opioid usage in upper limb and neck pain patients after 10-kHz spinal cord stimulation treatment: subanalysis of USA studies. Pain Manag. 2021;11:133–143.
Falowski SM, Moore GA, Cornidez EG, et al. Improved psychosocial and functional outcomes and reduced opioid usage following burst spinal cord stimulation. Neuromodulation. 2021;24:581–590.
Simopoulos T, Sharma S, Wootton RJ, et al. Discontinuation of chronic opiate therapy after successful spinal cord stimulation is highly dependent upon the daily opioid dose. Pain Pract. 2019;19:794–799.
Nissen M, Ikäheimo TM, Huttunen J, et al. Higher preimplantation opioid doses associated with long-term spinal cord stimulation failure in 211 patients with failed back surgery syndrome. Neuromodulation. 2021;24:102–111.
Al-Kaisy A, Van Buyten JP, Amirdelfan K, et al. Opioid-sparing effects of 10 kHz spinal cord stimulation: a review of clinical evidence. Ann N Y Acad Sci. 2020;1462:53–64.
Hsu ES. Medication overuse in chronic pain. Curr Pain Headache Rep. 2017;21:2.
Rudd RA. Increases in drug and opioid-involved overdose deaths—United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016;65:1445–1452.
Busse JW, Wang L, Kamaleldin M, et al. Opioids for chronic noncancer pain: a systematic review and meta-analysis. JAMA. 2018;320:2448–2460.
Gee C, Smith J, Ghulam-Jelani E, et al. Spinal cord stimulation for the treatment of chronic pain reduces opioid use and results in superior clinical outcomes when used without opioids. Neurosurgery. 2019;84:217–226.
Yan E, Kuo DJ. I just need an opioid refill to get me through the weekend. J Med Ethics. 2019;45:219–224.
Vowles KE, McEntee ML, Julnes PS, et al. Rates of opioid misuse, abuse and addiction in chronic pain. Pain. 2015;156:569–576.
Overdose Death Rates. National Institute on Drug Abuse (NIDA). Available at: http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates . Accessed July 1, 2020.
Theisen K, Jacobs B, Macleod L, et al. The United States opioid epidemic: a review of the surgeon’s contribution to it and health policy initiatives. BJU Int. 2018;122:754–759.
Encinosa W, Bernard D, Selden TM. Opioid and non-opioid analgesic prescribing before and after the CDC’s 2016 opioid guideline. Int J Health Econ Manag. 2022;22:1–52.
Kumar K, Rizvi S. Cost-effectiveness of spinal cord stimulation therapy in management of chronic pain. Pain Med. 2013;14:1631–1649.
Taylor RS, Ryan J, O’Donnell R, et al. The cost effectiveness of spinal cord stimulation for the treatment of failed back surgery syndrome. Clin J Pain. 2010;26:463–469.
Cameroon T. Safety and efficacy of spinal cord stimulation for treatment of chronic pain: a 20-year literature review. J Neurosurg. 2004;100(3 suppl Spine):254–267.
Simpson EL, Duenas A, Holmes MW, et al. Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin: systematic review and economic evaluation. Health Technol Assess. 2009;13:iii; ix–x, 1–154.
Taylor RJ, Taylor RS. Spinal cord stimulation for failed back surgery syndrome: a decision-analytic model and cost-effectiveness analysis. Int J Technol Assess Health Care. 2005;21:351–358.
North RB, Kidd DH, Farrokhi F, et al. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56:98–106.
Taylor RS, Van Buyten JP, Buchser E. Spinal cord stimulation for complex regional pain syndrome: a systematic review of the clinical and cost-effectiveness literature and assessment of prognostic factors. Eur J Pain. 2006;10:91–101.
Börjesson M, Andrell P, Lundberg D, et al. Spinal cord stimulation in severe angina pectoris—a systematic review based on the Swedish Council on Technology assessment in health care report on long-standing pain. Pain. 2008;140:501–508.
de Vos CC, Meier K, Zaalberg PB, et al. Spinal cord stimulation in patients with painful diabetic neuropathy: a multicentre randomized clinical trial. Pain. 2014;155:2426–2431.
Kumar K, Toth C, Nath RK, et al. Epidural spinal cord stimulation for treatment of chronic pain—some predictors of success. A 15-year experience. Surg Neurol. 1998;50:110–120.
Labaran L, Aryee JNA, Bell J, et al. Opioids and spinal cord stimulators: pre- and postoperative opioid use patterns and predictors of prolonged postoperative opioid use. Neurospine. 2020;17:246–253.
Smith WJ, Cedeño DL, Thomas SM, et al. Modulation of microglial activation states by spinal cord stimulation in an animal model of neuropathic pain: comparing high rate, low rate, and differential target multiplexed programming. Mol Pain. 2021;17:1744806921999013.
Morales A, Yong RJ, Kaye AD, et al. Spinal cord stimulation: comparing traditional low-frequency tonic waveforms to novel high frequency and burst stimulation for the treatment of chronic low back pain. Curr Pain Headache Rep. 2019;23:25.
Haider N, Ligham D, Quave B, et al. Spinal cord stimulation (SCS) trial outcomes after conversion to a multiple waveform SCS system. Neuromodulation. 2018;21:504–507.
Pollard EM, Lamer TJ, Moeschler SM, et al. The effect of spinal cord stimulation on pain medication reduction in intractable spine and limb pain: a systematic review of randomized controlled trials and meta-analysis. J Pain Res. 2019;12:1311–1324.
Al-Kaisy A, Van Buyten JP, Smet I, et al. Sustained effectiveness of 10 kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study. Pain Med. 2014;15:347–354.
Khan H, Pilitsis JG, Prusik J, et al. Pain remission at one-year follow-up with spinal cord stimulation. Neuromodulation. 2018;21:101–105.
Lee M, Silverman SM, Hansen H, et al. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14:145–161.
Fraifeld EM, Hatheway JA, Ricker CN. Systemic opioid prescribing patterns and total cost of care in patients initiating spinal cord stimulation therapy: a retrospective analysis. Pain Med. 2021;22:784–799.
Kumar K, Wilson JR. Factors affecting spinal cord stimulation outcome in chronic benign pain with suggestions to improve success rate. Acta Neurochir Suppl. 2007;97(pt 1):91–99.
Kumar K, Rizvi S, Nguyen R, et al. Impact of wait times on spinal cord stimulation therapy outcomes. Pain Pract. 2014;14:709–720.
Lad SP, Petraglia FW III, Kent AR, et al. Longer delay from chronic pain to spinal cord stimulation results in higher healthcare resource utilization. Neuromodulation. 2016;19:469–476.
Wilson JM, Farley KX, Bradbury TL, et al. Preoperative opioid use is a risk factor for complication and increased healthcare utilization following revision total knee arthroplasty. Knee. 2020;27:1121–1127.

MeSH Term

Analgesics, Opioid
Chronic Pain
Humans
Neuralgia
Opioid-Related Disorders
Pain Management
Spinal Cord
Spinal Cord Stimulation
Treatment Outcome

Chemicals

Analgesics, Opioid
Journal Article Systematic Review

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