The Role of Spinal Cord Stimulation in Reducing Opioid Use in the Setting of Chronic Neuropathic Pain

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.

Durable responses at 24 months with high-frequency spinal cord stimulation for nonsurgical refractory back pain

“…SCS therapy provides an opportunity for patients with chronic pain to reduce opioid use, which we and others have observed. 16,[32][33][34] We suggest that earlier use of SCS may help patients minimize adverse effects and increased healthcare utilization associated with the long-term use of opioids. Long delays in treatment are also problematic because increased pain onset-to-SCS implant time is associated with lower efficacy for pain relief and higher healthcare resource utilization after implantation.…”

Issues in patient cohort, surrogate outcome measures and conflicts of interest of JAMA Neurology's Dhruva et al. propensity‐matched retrospective evaluation of a single insurer administrative claims data of spinal cord stimulation compared with conventional medical therapy for chronic pain

“…Several studies have reported opioid reduction following implantation of SCS devices including a recent systematic review which concluded that SCS can lead to a reduction or elimination of chronic opioid use 11 . Similar conclusions were reported in several evaluations of insurance claims databases not mentioned by Dhruva et al 12–14 It is paramount that authors discuss their findings in light of previous literature, which has not happened in this instance and as such we are unclear as to the authors' possible explanations for this disparity in findings.…”

Optimizing Preoperative Chronic Pain Management in Elective Spine Surgery Patients

“…However, the literature is conflicting regarding whether these devices reduce opioid use 30,[50][51][52][53] , especially to a clinically significant degree 30 . Hwang et al found that 20% of patients had a decreased daily opioid dose a year after SCS implantation compared with preoperative doses while 40% saw no change.…”