BMI as a Predictor of Spinal Cord Stimulation Success in Chronic Pain Patients

Marola, Olivia J.; Cherala, Rasan; Prusik, Julia; Kumar, Vignessh; Wilock, Meghan; Crimmins, Jordan; Pilitsis, Julie G.

doi:10.1111/ner.12482

Cited by 34 publications

(35 citation statements)

References 29 publications

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“…The quest to obtain optimal therapeutic results has prompted investigations to determine helpful predictive parameters. Mounting evidence now suggests increased body mass index, smoking, substance abuse, feelings of demoralization, and psychiatric illness (particularly untreated depression) tend to correlate with less favorable outcomes . Dysfunctional coping profiles as determined by the Multidimensional Pain Inventory (MPI) are also associated with increased likelihood of both SCS trial failure as well as dissatisfaction with the final outcome, being device explantation …”

Section: Introductionmentioning

confidence: 99%

“…Mounting evidence now suggests increased body mass index, smoking, substance abuse, feelings of demoralization, and psychiatric illness (particularly untreated depression) tend to correlate with less favorable outcomes. [6][7][8] Dysfunctional coping profiles as determined by the Multidimensional Pain Inventory (MPI) are also associated with increased likelihood of both SCS trial failure as well as dissatisfaction with the final outcome, being device explantation. 9 Chronic opioid therapy (COT) is widely used in patients with high levels of pain, especially those in whom multiple prior treatments have failed.…”

Section: Introductionmentioning

confidence: 99%

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Discontinuation of Chronic Opiate Therapy After Successful Spinal Cord Stimulation Is Highly Dependent Upon the Daily Opioid Dose

Simopoulos

Sharma

Wootton³

et al. 2019

Pain Practice

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Objectives The aim of this study was to determine if any of the factors recorded on a standard clinical history of a patient considered for spinal cord stimulation (SCS) would be associated with reduction or cessation of opioids following implantation. Design Retrospective, single academic center. Methods Patients included in the chart analysis underwent implantation of percutaneous SCS devices from 1999 to 2015 with follow‐up until the end of September 2018. Patients who achieved at least an average of 50% pain reduction were included for analysis of daily opioid intake. Patients were then divided into 4 groups that included no opioid use, stable opioid daily dose, weaned opioid dose, and complete cessation of opioids. Statistical methods were used to analyze for associations between opioid intake after SCS insertion and usual elements of a clinical history, including adjuvant medications, numeric pain rating, past medical history, psychiatric illness, substance abuse, employment, and smoking history. Results In a group of 261 patients who had undergone implantation, 214 met the criteria for analysis and had a median age of 50 years, with majority having the diagnoses of failed back surgery syndrome and complex regional pain syndrome. The only factor that was associated with complete cessation of opioid use was a median dose of 30 mg of morphine per day (P < 0.01) and was observed in 15% of subjects who used opioids preoperatively. Conclusion The elimination of opioid dependence following initiation of SCS therapy is highly dependent on the daily dose.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Discontinuation of Chronic Opiate Therapy After Successful Spinal Cord Stimulation Is Highly Dependent Upon the Daily Opioid Dose

Simopoulos

Sharma

Wootton³

et al. 2019

Pain Practice

View full text Add to dashboard Cite

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“…22,23 Marola et al reported a higher complication rate among patients with BMI > 36.5 in a retrospective review of 77 patients undergoing SCS implantation. 23 Similarly, in a retrospective study of 141 patients undergoing SCS implantation for chronic pain syndrome, Bir et al found that BMI > 30 kg/m 2 was predictive of need for early revision after surgery due to mechanical complications such as hardware malfunction or lead migration. 22 These mechanical complications are likely attributable to technical challenges inherent to operating on obese patients, as patient positioning and tissue depth can interfere with lead and generator placement.…”

Section: Discussionmentioning

confidence: 99%

“…22 These mechanical complications are likely attributable to technical challenges inherent to operating on obese patients, as patient positioning and tissue depth can interfere with lead and generator placement. 23,24 In addition to mechanical complications, high BMI has been linked with increased post-operative infections after spinal surgery. 25–28 Both of these complications contribute to the association between obesity and increased 30-day readmission rates seen both in the spine surgery literature 29–31 and in our study.…”

Section: Discussionmentioning

confidence: 99%

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Drivers and Risk Factors of Unplanned 30-Day Readmission Following Spinal Cord Stimulator Implantation

Elsamadicy

Sergesketter

Ren

et al. 2018

Neuromodulation: Technology at the Neural Interface

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Our study suggests that infectious and mechanical complications are the primary drivers of unplanned 30-day readmission after SCS implantation, with obesity as an independent predictor of unplanned readmission. Given the technological advancements in SCS, repeated studies are necessary to identify factors associated with unplanned 30-day readmission rates after SCS implantation to improve patient outcomes and reduce associated costs.

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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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BMI as a Predictor of Spinal Cord Stimulation Success in Chronic Pain Patients

Cited by 34 publications

References 29 publications

Discontinuation of Chronic Opiate Therapy After Successful Spinal Cord Stimulation Is Highly Dependent Upon the Daily Opioid Dose

Discontinuation of Chronic Opiate Therapy After Successful Spinal Cord Stimulation Is Highly Dependent Upon the Daily Opioid Dose

Drivers and Risk Factors of Unplanned 30-Day Readmission Following Spinal Cord Stimulator Implantation

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

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