According to new research, spinal cord stimulation (SCS) therapy can help reduce the amount of opioids needed to manage chronic pain.
Researchers studied opioid usage data from more than 5,400 patients both prior to, and after receiving SCS therapy. They found that average daily opioid use declined or stabilized for those using a successful SCS system compared to patient use of opioids prior to an implant. A successful SCS system is one that a patient undergoes a temporary trial of the therapy and find that it relieves pain, and then they receive the permanent implant. An unsuccessful SCS system is one that the patient does not gain pain relief during the trial period.
Opioid usage was not different for the two groups at time of implant. Those who underwent a successful SCS implant had significantly lower opioid use one year after their implant. Patients who had their SCS system removed saw their opioid use increase again over time.
The study, which the researchers believe makes a compelling case for considering SCS therapy earlier in the chronic pain care continuum, were presented today at the 2017 North American Neuromodulation Society (NANS) annual meeting by Ashwini Sharan, M.D., director of Functional and Epilepsy Surgery at Vickie and Jack Farber Institute for Neuroscience at Jefferson and president of NANS.
“Given the epidemic of opioid addiction and abuse, these findings are important and confirm that spinal cord stimulation therapy can offer strong benefits for patients struggling with chronic pain,” said Sharan. “Based on these results, we concluded it may be possible to improve outcomes by offering our patients spinal cord stimulation earlier, before opioid dependence and addiction can occur.”
The researchers assessed private and Medicare insurance claims data from 5,476 patients who received an SCS system to treat chronic pain associated with a host of conditions (excluding pain related to cancer). The data were collected between January 2010 and December 2014.
The data confirmed that many patients are often prescribed increasing dosages of opioids prior to receiving an SCS system. The researchers also found:
- SCS therapy is effective for patients at any level of opioid usage prior to implantation.
- Opioid use declined or stabilized in 70 percent of patients who received an SCS system.
- Among patients who had their SCS system explanted, opioid use was higher at one year compared to those who continued with SCS therapy.
The researchers further suggested patient outcomes could be improved if SCS were implanted earlier in recognition of the clinical practice to provide increasing dosages of opioids over time. These conclusions help build upon prior research, such as results of a large multicenter randomized controlled trial in patients with failed back surgery syndrome (FBSS) that showed trends in opioid reduction or cessation among SCS patients. In addition, new technologies released in the U.S. in 2015 and 2016 hold promise to improve outcomes further and may reduce common complications resulting in explant such as the undesired changes in paresthesia, issues with charging, pain at the implantable pulse generator (IPG) site, and loss of pain relief.
“As our society has been seeking ways to stem opioid abuse and addition, our company offers treatment options that can reduce their exposure to opioid medication,” said Allen Burton, M.D., medical director of neuromodulation at Abbott. “Data like these are critical to helping us demonstrate that spinal cord stimulation can reduce exposure to opioids while giving patients comprehensive pain relief.”