Neuropathic Pain Medication Use Does Not Alter Outcomes of Spinal Cord Stimulation for Lower Extremity Pain

Maher, Dermot P.; Martins, Yuri Chaves; Doshi, Tina L.; Bicket, Mark C.; Zhang, Kui; Hanna, George M.; Ahmed, Shihab

doi:10.1111/ner.12697

Cited by 10 publications

(10 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with the latter, a significantly higher proportion of the patients in the explanted group had ICD‐10 diagnostic code either for major depressive disorder or neurotic, stress‐related and somatoform disorders compared to the permanent group. A multinomial logistic regression revealed that diazepam use prior to surgery was associated with a 2.4‐fold increase in the risk of explanting of SCS, and starting clonazepam use after SCS implantation was associated with a 5.2‐fold increase in the risk for unsuccessful trial stimulation, which is contrary to the results of a previous study that found no increase in the risk of unsuccessful SCS in benzodiazepine users (Table ) . In addition, contrary to the results of previous studies, age was not associated with poor SCS outcome in this study, and gender was only significant in predicting unsuccessful trial stimulation, not explanting of SCS .…”

Section: Discussioncontrasting

confidence: 99%

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

Määttä

Martikainen

Ikäheimo

et al. 2020

Neuromodulation: Technology at the Neural Interface

View full text Add to dashboard Cite

Section: Discussioncontrasting

confidence: 99%

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

Määttä

Martikainen

Ikäheimo

et al. 2020

Neuromodulation: Technology at the Neural Interface

View full text Add to dashboard Cite

“…The bulk of the existing SCS literature describes outcomes using conventional tonic stimulation, in which electrical pulses are delivered in a consistent repetitive fashion (4)(5)(6)(7). Burst stimulation (Abbott, Plano, TX, USA) delivers packets of stimulation-five pulses at 500 Hz-at a frequency of 40 Hz with repolarization occurring passively during the inter-burst interval (8).…”

Section: Introductionmentioning

confidence: 99%

Novel Intermittent Dosing Burst Paradigm in Spinal Cord Stimulation

Deer

Patterson

Baksh³

et al. 2021

Neuromodulation: Technology at the Neural Interface

View full text Add to dashboard Cite

Introduction: Intermittent dosing (ID), in which periods of stimulation-on are alternated with periods of stimulation-off, is generally employed using 30 sec ON and 90 sec OFF intervals with burst spinal cord stimulation (SCS). The goal of this study was to evaluate the feasibility of using extended stimulation-off periods in patients with chronic intractable pain.Materials and Methods: This prospective, multicenter, feasibility trial evaluated the clinical efficacy of the following ID stimulation-off times: 90, 120, 150, and 360 sec with burst waveform parameters. After a successful trial (≥50% pain relief) using ID stimulation, subjects were titrated with OFF times beginning with 360 sec. Pain, quality of life, disability, and pain catastrophizing were evaluated at one, three, and six months after permanent implant.Results: Fifty subjects completed an SCS trial using ID stimulation settings of 30 sec ON and 90 sec OFF, with 38 (76%) receiving ≥50% pain relief. Pain scores were significantly reduced from baseline at all time points (p < 0.001). Improvements in quality of life, disability, and pain catastrophizing were aligned with pain relief outcomes; 45.8% of the subjects that completed the six-month follow-up visit used an OFF period of 360 seconds.Conclusions: ID burst SCS effectively relieved pain for six months. The largest group of subjects used IDB settings of 30 sec ON and 360 sec OFF. These findings present intriguing implications for the optimal "dose" of electricity in SCS and may offer many advantages such as optimizing the therapeutic window, extending battery life, reducing recharge burden and, potentially, mitigating therapy habituation or tolerance.

show abstract

“…In contrast to previous studies, opioid use remained the same or increased in different groups. 28,39,40 No statistically significant differences occurred in the use of neuropathic medication, but generally, there was a downward trend. The corresponding results have been reported previously.…”

Section: Discussionmentioning

confidence: 94%

Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome

et al. 2021

View full text Add to dashboard Cite

BACKGROUND Spinal cord stimulation (SCS) is an effective treatment in chronic neuropathic pain, but its efficacy in complex regional pain syndrome (CRPS) needs to be proven. OBJECTIVE To study the outcome of SCS in CRPS as measured by trial success, explantation rate, complications, and changes in opioid and neuropathic pain medication use over a 4-yr follow-up. METHODS We retrospectively reviewed all medical records of 35 consecutive CRPS patients who underwent SCS trials at 2 hospitals during January 1998 to December 2016. The purchase data of opioids and neuropathic pain medication during January 1995 to March 2016 were retrieved from national registries. RESULTS Based on a 1-wk trial, permanent SCS was implanted in 27 (77%) patients. During the median follow-up of 8 yr, 8 (30%) SCS devices were explanted, of which 7 were because of inefficient pain relief. Complications leading to revision occurred in 17 (63%) patients: 8 electrode migrations or stimulation to the wrong area, 1 deep infection, 9 hardware malfunctions, 2 pulse generator discomforts, and 2 SCS replacements. None of the 6 patients using strong opioids discontinued their use during the 2-yr follow-up. The mean opioid dose increased nonsignificantly both in patients with SCS in permanent use (53 ± 150 morphine milligram equivalents morphine milligram equivalent (MME)/day to 120 ± 240 MME/day) and in patients who had SCS explanted (27 ± 72 MME/day to 57 ± 66 MME/day). CONCLUSION Despite the fact that CRPS patients were not able to discontinue or reduce their strong opioid or neuropathic pain medication use, 70% continued to use their SCS device during a median 8-yr follow-up.

show abstract

Neuropathic Pain Medication Use Does Not Alter Outcomes of Spinal Cord Stimulation for Lower Extremity Pain

Cited by 10 publications

References 25 publications

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

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

Novel Intermittent Dosing Burst Paradigm in Spinal Cord Stimulation

Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome

Contact Info

Product

Resources

About