Benzodiazepine Use Is Associated With Poorer Spinal Cord Stimulation Outcome in 373 Neuropathic Pain Patients

Määttä, Jaakko; Martikainen, Antti; Ikäheimo, Tiina‐Mari; Nissen, Mette; Viinamäki, Heimo; Fraunberg, Mikael von und zu; Huttunen, Jukka

doi:10.1111/ner.13045

Cited by 4 publications

(4 citation statements)

References 32 publications

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“…We included 41 studies,7 9 113–151 with 13 of them specifically evaluating trial outcomes or its predictors or trial-related parameters9 113 118–123 127 137 138 143 147 150 (table 4). The remaining studies evaluated predictors of therapy response related to non-pain characteristics.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies used CS, two studies used mixed stimulation,124 132 and one study reported both BS and HFS modes 137. Among reported studies, the trial duration ranged from 0 to 56 days,114 with a median of 7 days.…”

Section: Resultsmentioning

confidence: 99%

“…Intraoperative and postoperative electromyography and somatosensory evoked potential monitoring were used in one study to capture painful areas and activate contacts to be used 142. Prior diazepam use increased the odds of explantation by 2.4-fold and starting clonazepam after SCS increased the odds of unsuccessful trials by a 5.2-fold 124. In one study, gabapentin use did not change the results of either the trials or permanent outcomes and a higher baseline opioid dose was associated with increased odds of 50% opioid reduction after SCS implant,125 similar to other studies 133.…”

Section: Resultsmentioning

confidence: 99%

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Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

Shanthanna

Eldabe

Provenzano³

et al. 2023

Reg Anesth Pain Med

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Background/importancePatient selection for spinal cord stimulation (SCS) therapy is crucial and is traditionally performed with clinical selection followed by a screening trial. The factors influencing patient selection and the importance of trialing have not been systematically evaluated.ObjectiveWe report a narrative review conducted to synthesize evidence regarding patient selection and the role of SCS trials.Evidence reviewMedline, EMBASE and Cochrane databases were searched for reports (any design) of SCS in adult patients, from their inception until March 30, 2022. Study selection and data extraction were carried out using DistillerSR. Data were organized into tables and narrative summaries, categorized by study design. Importance of patient variables and trialing was considered by looking at their influence on the long-term therapy success.FindingsAmong 7321 citations, 201 reports consisting of 60 systematic reviews, 36 randomized controlled trials (RCTs), 41 observational studies (OSs), 51 registry-based reports, and 13 case reports on complications during trialing were included. Based on RCTs and OSs, the median trial success rate was 72% and 82%, and therapy success was 65% and 61% at 12 months, respectively. Although several psychological and non-psychological determinants have been investigated, studies do not report a consistent approach to patient selection. Among psychological factors, untreated depression was associated with poor long-term outcomes, but the effect of others was inconsistent. Most RCTs except for chronic angina involved trialing and only one RCT compared patient selection with or without trial. The median (range) trial duration was 10 (0–30) and 7 (0–56) days among RCTs and OSs, respectively.ConclusionsDue to lack of a consistent approach to identify responders for SCS therapy, trialing complements patient selection to exclude patients who do not find the therapy helpful and/or intolerant of the SCS system. However, more rigorous and large studies are necessary to better evaluate its role.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

Shanthanna

Eldabe

Provenzano³

et al. 2023

Reg Anesth Pain Med

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“…It is likely that preimplant neuropathic pain medications (considered as gabapentinoids, tricyclic antidepressants, serotonin, and norepinephrine reuptake inhibitors) have no influence,80 although a recent study observed reduced risk of explant in those using gabapentinoid medications prior their SCS trial 85. A case–control study that tested the association of benzodiazepine use and SCS outcomes, noting that benzodiazepine use during the 24-month period before or after SCS implantation was associated with increased risk of explantation and unsuccessful trial stimulation 86. We need to consider that the use of benzodiazepine may be a reflection of an underlying diagnosis of depression, which is noted to be associated with poor outcomes, and also others such as anxiety or stress related disorders.…”

Section: Committee Statements and Recommendationsmentioning

confidence: 99%

Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain

Shanthanna

Eldabe

Provenzano³

et al. 2023

Reg Anesth Pain Med

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Spinal cord stimulation (SCS) has demonstrated effectiveness for neuropathic pain. Unfortunately, some patients report inadequate long-term pain relief. Patient selection is emphasized for this therapy; however, the prognostic capabilities and deployment strategies of existing selection techniques, including an SCS trial, have been questioned. After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, a steering committee was formed to develop evidence-based guidelines for patient selection and the role of an SCS trial. Representatives of professional organizations with clinical expertize were invited to participate as committee members. A comprehensive literature review was carried out by the steering committee, and the results organized into narrative reports, which were circulated to all the committee members. Individual statements and recommendations within each of seven sections were formulated by the steering committee and circulated to members for voting. We used a modified Delphi method wherein drafts were circulated to each member in a blinded fashion for voting. Comments were incorporated in the subsequent revisions, which were recirculated for voting to achieve consensus. Seven sections with a total of 39 recommendations were approved with 100% consensus from all the members. Sections included definitions and terminology of SCS trial; benefits of SCS trial; screening for psychosocial characteristics; patient perceptions on SCS therapy and the use of trial; other patient predictors of SCS therapy; conduct of SCS trials; and evaluation of SCS trials including minimum criteria for success. Recommendations included that SCS trial should be performed before a definitive SCS implant except in anginal pain (grade B). All patients must be screened with an objective validated instrument for psychosocial factors, and this must include depression (grade B). Despite some limitations, a trial helps patient selection and provides patients with an opportunity to experience the therapy. These recommendations are expected to guide practicing physicians and other stakeholders and should not be mistaken as practice standards. Physicians should continue to make their best judgment based on individual patient considerations and preferences.

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Spinal cord stimulation and psychotropic medication use: Missing piece to the puzzle?

Hwang

Negoita

Duy

et al. 2020

Journal of Clinical Neuroscience

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Benzodiazepine Use Is Associated With Poorer Spinal Cord Stimulation Outcome in 373 Neuropathic Pain Patients

Cited by 4 publications

References 32 publications

Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain

Spinal cord stimulation and psychotropic medication use: Missing piece to the puzzle?

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