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Yong RJ, Tran OV, McGovern AM, Patil PG, Gilligan CJ. Long-Term Reductions in Opioid Medication Use After Spinal Stimulation: A Claims Analysis Among Commercially-Insured Population. J Pain Res 2024; 17:1773-1784. [PMID: 38784716 PMCID: PMC11111580 DOI: 10.2147/jpr.s441195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/26/2024] [Indexed: 05/25/2024] Open
Abstract
Purpose Chronic, non-cancer pain significantly and negatively impacts patient quality of life. Neuromodulation is a major component of multi-modal interdisciplinary approaches to chronic pain management, which includes opioid and nonopioid medications. In randomized controlled trials, spinal cord stimulation (SCS) has been shown to reduce pain and decrease short-term opioid use for patients. This study sought to evaluate the effect of SCS on longer term opioid and non-opioid pain medication usage among patients over ≥3 years of follow-up. Patients and Methods Claims analysis was conducted using the Merative™ MarketScan® Commercial Database. Patients aged ≥18 who initiated SCS between 1/1/2010 and 3/31/2021 with ≥1 year of baseline data and ≥3 years of follow-up data were included. Opioid discontinuation, daily dose (DD) reduction, proportion of days covered (PDC), concomitant co-medication with benzodiazepines and/or gabapentinoids, and polypharmacy were evaluated during the baseline and follow-up periods. Adjusted logistic regression was used to evaluate the impact of baseline dosages on discontinuation and dose reduction. Results During follow-up, 60% of 2,669 SCS patients either discontinued opioid use or reduced opioid DD by at least 20% from baseline; another 15% reduced DD by 1-19%. Logistic regression showed patients with higher baseline dosages were less likely to discontinue opioids completely (odds ratio[OR] 95% confidence intervals[CI]: 0.31[0.18,0.54]) but more likely to reduce their daily dose (OR[CI]: 7.14[4.00,12.73], p<0.001). Mean PDC with opioids decreased from 0.58 (210 of 365 days) at baseline to 0.51 at year 3 (p<0.001). With SCS, co-medication with benzodiazepines decreased from 47.3% at baseline to 30.3% at year 3, co-medication with gabapentinoids reduced from 58.6% to 42.2%, and polypharmacy dropped from 15.6% to 9.6% (all p<0.001). Conclusion Approximately three-quarters of patients who received SCS therapy either discontinued or reduced systemic opioid use over the study period. SCS could assist in reducing long-term reliance on opioids and other pain medications to treat chronic non-cancer pain.
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Affiliation(s)
- Robert Jason Yong
- Pain Management Center, Brigham and Women’s Hospital, Chestnut Hill, MA, USA
| | - Oth V Tran
- Health Economics and Outcomes Research, Boston Scientific Corporation, Marlborough, MA, USA
| | - Alysha M McGovern
- Health Economics and Outcomes Research, Boston Scientific Corporation, Marlborough, MA, USA
| | - Parag G Patil
- Neurological Surgery, University of Michigan, Ann Arbor, MI, USA
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Abdullah N, Sindt JE, Whittle J, Anderson JS, Odell DW, Mahan M, Brogan SE. Impact of neuromodulation on opioid use, adjunct medication use, and pain control in cancer-related pain: a retrospective case series. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:903-906. [PMID: 36625516 PMCID: PMC10321759 DOI: 10.1093/pm/pnad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Affiliation(s)
- Newaj Abdullah
- Division of Pain Medicine, Department of Anesthesiology, University of Utah, Salt Lake City, Utah 84108, USA
| | - Jill E Sindt
- Division of Pain Medicine, Department of Anesthesiology, University of Utah, Salt Lake City, Utah 84108, USA
| | - Jacob Whittle
- Division of Pain Medicine, Department of Anesthesiology, University of Utah, Salt Lake City, Utah 84108, USA
| | | | - Daniel W Odell
- Division of Pain Medicine, Department of Anesthesiology, University of Utah, Salt Lake City, Utah 84108, USA
| | - Mark Mahan
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84108, USA
| | - Shane E Brogan
- Division of Pain Medicine, Department of Anesthesiology, University of Utah, Salt Lake City, Utah 84108, USA
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Hayek SM, Eldabe S. Recent Publication by Dhruva et al in JAMA Neurology: Cui Bono? (To Whom Is It a Benefit?). Neuromodulation 2023; 26:704. [PMID: 37028888 DOI: 10.1016/j.neurom.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Salim M Hayek
- Division of Pain Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Anesthesiology/Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Sam Eldabe
- Department of Pain Medicine, the James Cook University Hospital, Middlesbrough, UK
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Bodnar RJ. Endogenous opiates and behavior: 2021. Peptides 2023; 164:171004. [PMID: 36990387 DOI: 10.1016/j.peptides.2023.171004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
This paper is the forty-fourth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2021 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonizts and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY 11367, USA.
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Sherwood D, Rivers WE, Hunt C, McCormick Z, de Andres J, Schneider BJ. Commentary on recent spinal cord stimulation publications. INTERVENTIONAL PAIN MEDICINE 2023; 2:100241. [PMID: 39239607 PMCID: PMC11373018 DOI: 10.1016/j.inpm.2023.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 09/07/2024]
Affiliation(s)
- David Sherwood
- University Health - Lakewood Medical Center, Department of Orthopedics, 7900 Lee's Summit Rd, Kansas City, MO, 64139, United States
| | | | | | | | - Jose de Andres
- General University Hospital Consortium of Valencia, Spain
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Rupp A, Francio VT, Hagedorn JM, Deer T, Sayed D. The impact of spinal cord stimulation on opioid utilization in failed back surgery syndrome and spinal surgery naïve patients. INTERVENTIONAL PAIN MEDICINE 2022; 1:100148. [PMID: 39238856 PMCID: PMC11372956 DOI: 10.1016/j.inpm.2022.100148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 09/07/2024]
Abstract
Background Spinal cord stimulation (SCS) has been utilized for failed back surgery syndrome (FBSS) with well-documented improvements in pain and function. However, limited studies have investigated the relationship between spinal surgery, SCS and opioid use outcomes. Methods A narrative review utilizing the scale for the quality assessment of narrative review articles (SANRA) methodology looking at trials involving SCS and opiates. Results Twenty-six studies met inclusion criteria. Surgery-naïve subjects had the greatest mean opioid dose reduction of 50.39% morphine milliequivalents, and the greatest number of patients who discontinued opioids at 53.72%. No statistical analysis was performed due to heterogeneous data. Conclusion SCS has a positive impact on opioid reduction, regardless of prior spinal surgical history. However, due to a lack of homogenous data, a formal conclusion comparing outcomes between spinal surgical histories cannot be drawn. There is an inherent difficulty in evaluating this topic given its complexity and multifactorial origin. Studies would require collaboration between pain physicians, societies and industry. Even then, patient biases such as psychological and expectation would be difficult to account for. This topic remains an ongoing challenge for interventional pain physicians.
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Affiliation(s)
- Adam Rupp
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Timothy Deer
- The Spine & Nerve Centers of the Virginias, Charleston, WV, USA
| | - Dawood Sayed
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
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Smith CA, Roman J, Mammis A. The Role of Spinal Cord Stimulation in Reducing Opioid Use in the Setting of Chronic Neuropathic Pain: A Systematic Review. Clin J Pain 2022; 38:285-291. [PMID: 35132028 DOI: 10.1097/ajp.0000000000001021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/24/2022] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Cynthia A Smith
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Jessica Roman
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Antonios Mammis
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY
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Vu TN, Khunsriraksakul C, Vorobeychik Y, Liu A, Sauteraud R, Shenoy G, Liu DJ, Cohen SP. Association of Spinal Cord Stimulator Implantation With Persistent Opioid Use in Patients With Postlaminectomy Syndrome. JAMA Netw Open 2022; 5:e2145876. [PMID: 35099546 PMCID: PMC8804916 DOI: 10.1001/jamanetworkopen.2021.45876] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The results of studies evaluating spinal cord stimulation (SCS) for postlaminectomy syndrome (PLS) have yielded mixed results. This has led to an increased emphasis on objective outcome measures such as opioid prescribing. OBJECTIVE To determine the association between SCS and long-term opioid therapy (LOT) for PLS. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, adults with PLS were identified using the TriNetx Diamond Network and separated based on whether they underwent SCS. Patients were stratified according to baseline opioid use (opioid-naive or receiving LOT) and subsequent opioid therapy over the 12-month period ranging from 3 to 15 months post-SCS implantation or post-PLS index date. Statistical analysis was performed from June to December 2021. EXPOSURE SCS. MAIN OUTCOMES AND MEASURES The main outcome was cessation of opioid use among patients receiving LOT or abstinence from opioids among opioid-naive patients. Opioid-naive patients were defined as those receiving at most 2 opioid prescriptions per year, and patients on LOT were those receiving at least 6 opioid prescriptions per year. RESULTS Among 552 937 eligible patients treated between December 2015 and May 2021, 26 179 with PLS received an SCS implant. The median (IQR) patient age was 60 (51-69) years; 305 802 patients (55.3%) were female. Among those reporting racial identify (37.0% [204 758 patients]), 9.3% (18 971 patients) were African American, 0.3% (648 patients) were Asian, and 90.4% (185 139 patients) were White. Compared with those who did not receive an SCS, individuals who received an SCS were more likely to be using opioids preimplantation (mean [SD] prescriptions: 4.3 [8.5] vs 4.1 [9.3]; P < .001) but less likely to be using opioids after SCS implantation (mean [SD] prescriptions: 3.8 [8.2] vs 4.0 [9.4]; P = .006). In the 12-month study period, similar proportions in the SCS and no-SCS groups receiving baseline LOT remained on LOT (70.3% [n = 74 585] vs 69.2% [n = 3882], respectively; P = .10). In opioid-naive patients, SCS was associated with a small decreased likelihood of patients subsequently receiving LOT (7.6% vs 7.0%; difference, -0.6% [95% CI, -1.0% to -0.2%]; P = .003). In multivariable analysis, SCS was associated with an increased likelihood of not being on opioids in both opioid-naive (adjusted odds ratio [OR], 0.90 [95% CI, 0.85-0.96]; P < .001) and LOT patients (adjusted OR, 0.93 [95% CI, 0.88-0.99]; P = .02). White patients were significantly more likely to be diagnosed with PLS (ie, underwent surgery) (90.4% vs 85.2%; difference, 5.2% [95% CI, 5.1%-5.4%]; P < .001) and receive an SCS (93.7% vs 90.3%; difference, 3.4% [95% CI, 2.9% to 4.0%]; P < .001) than patients of other racial identities. CONCLUSIONS AND RELEVANCE These findings suggest that under real-life conditions, SCS was associated with small, clinically questionable associations with opioid discontinuation and not starting opioids in the context of PLS.
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Affiliation(s)
- To-Nhu Vu
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Yakov Vorobeychik
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Alison Liu
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Renan Sauteraud
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ganesh Shenoy
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Dajiang J. Liu
- Departments of Public Health Sciences and Biochemistry & Molecular Biology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Steven P. Cohen
- Departments of Anesthesiology and Critical Care Medicine, Physical Medicine & Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
- Departments of Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Affiliation(s)
- Richard B North
- Neurosurgery, Anesthesiology and Critical Care Medicine (ret.), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ashwini D Sharan
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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