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7. 346 Durable Responses at 24 Months With High-Frequency Spinal Cord Stimulation for Nonsurgical Refractory Back Pain

Author

Patel, Naresh P., primary, Kapural, Leonardo, additional, Jameson, Jessica, additional, Johnson, Curtis, additional, Kloster, Dan, additional, Calodney, Aaron K., additional, Kosek, Peter, additional, Pilitsis, Julie G., additional, Bendel, Markus A., additional, Petersen, Erika A., additional, Wu, Chengyuan, additional, Cherry, Taissa, additional, Lad, Nandan P., additional, Yu, Cong, additional, Sayed, Dawood, additional, and Province-Azalde, Rose, additional

Published
2024
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10. Comparing Methods for Identifying Post-Market Patient Preferences at the Point of Decision-Making: Insights from Patients with Chronic Pain Considering a Spinal Cord Stimulator Device.

Author

Golembiewski, Elizabeth H, Leon-Garcia, Montserrat, Gravholt, Derek Loy, Brito, Juan P, Spatz, Erica S, Bendel, Markus A, Montori, Victor M, Maraboto, Andrea P, Hartasanchez, Sandra A, and Hargraves, Ian G

Subjects
PATIENT preferences, SPINAL cord, CHRONIC pain, VIDEO coding, ACADEMIC medical centers
Abstract

Purpose: To compare three methods for identifying patient preferences (MIPPs) at the point of decision-making: analysis of video-recorded patient-clinician encounters, post-encounter interviews, and post-encounter surveys. Patients and Methods: For the decision of whether to use a spinal cord stimulator device (SCS), a video coding scheme, interview guide, and patient survey were iteratively developed with 30 SCS decision-making encounters in a tertiary academic medical center pain clinic. Burke's grammar of motives was used to classify the attributed source or justification for a potential preference for each preference block. To compare the MIPPs, 13 patients' encounters with their clinician were video recorded and subsequently analyzed by 4 coders using the final video coding scheme. Six of these patients were interviewed, and 7 surveyed, immediately following their encounters. Results: For videos, an average of 66 (range 33– 106) sets of utterances potentially indicating a patient preference (a preference block), surveys 33 (range 32– 34), and interviews 25 (range 18– 30) were identified. Thirty-eight unique themes (75 subthemes), each a preference topic, were identified from videos, surveys 19 themes (12 subthemes), and interviews 39 themes (54 subthemes). The proportion of preference blocks that were judged as expressing a preference that was clearly important to the patient or affected their decision was highest for interviews (72.8%), surveys (68.0%), and videos (27.0%). Videos mostly attributed preferences to the patient's situation (scene) (65%); interviews, the act of receiving or living with SCS (43%); surveys, the purpose of SCS (40%). Conclusion: MIPPs vary in the type of preferences identified and the clarity of expressed preferences in their data sets. The choice of which MIPP to use depends on projects' goals and resources, recognizing that the choice of MIPP may affect which preferences are found. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Ganglion Impar Block

Author

Bendel, Markus A., Deer, Timothy R., editor, Pope, Jason E., editor, Lamer, Tim J., editor, and Provenzano, David, editor

Published
2019
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12. O005 / #371 24-MONTH RANDOMIZED CONTROLLED TRIAL OUTCOMES OF HIGH-FREQUENCY (10 KHZ) SPINAL CORD STIMULATION FOR NONSURGICAL CHRONIC LOW BACK PAIN

Author

Kapural, Leonardo, primary, Jameson, Jessica, additional, Johnson, Curtis, additional, Kloster, Daniel, additional, Calodney, Aaron, additional, Kosek, Peter, additional, Pilitsis, Julie, additional, Bendel, Markus, additional, Petersen, Erika, additional, Wu, Chengyuan, additional, Cherry, Taissa, additional, Lad, Shivanand, additional, Yu, Cong, additional, Sayed, Dawood, additional, Azalde, Rose, additional, Caraway, David, additional, and Patel, Naresh, additional

Published
2023
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13. Durable responses at 24 months with high-frequency spinal cord stimulation for nonsurgical refractory back pain

Author

Patel, Naresh P., primary, Jameson, Jessica, additional, Johnson, Curtis, additional, Kloster, Daniel, additional, Calodney, Aaron, additional, Kosek, Peter, additional, Pilitsis, Julie, additional, Bendel, Markus, additional, Petersen, Erika, additional, Wu, Chengyuan, additional, Cherry, Taissa, additional, Lad, Shivanand, additional, Yu, Cong, additional, Sayed, Dawood, additional, Goree, Johnathan, additional, Lyons, Mark K., additional, Sack, Andrew, additional, Bruce, Diana, additional, Bharara, Manish, additional, Province-Azalde, Rose, additional, Caraway, David, additional, and Kapural, Leonardo, additional

Published
2023
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20. ID: 218085 Treating Non-Surgical Refractory Back Pain With 10kHz Spinal Cord Stimulation: 24 Month Follow-Up From RCT

Author

Kapural, Leonardo, primary, Jameson, Jessica, additional, Patel, Naresh, additional, Johnson, Curtis, additional, Kloster, Daniel, additional, Calodney, Aaron, additional, Pilitsis, Julie, additional, Bendel, Markus, additional, Petersen, Erika, additional, Wu, Chengyuan, additional, Cherry, Taissa, additional, Lad, Nandan, additional, Yu, Cong, additional, Sayed, Dawood, additional, Goree, Johnathan, additional, Lyons, Mark, additional, Sacks, Andrew, additional, Bruce, Diana, additional, Province-Azalde, Rose, additional, and Caraway, David, additional

Published
2023
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21. Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants

Author

Bendel, Markus A., O’Brien, Travis, Hoelzer, Bryan C., Deer, Timothy R., Pittelkow, Thomas P., Costandi, Shrif, Walega, David R., Azer, Gerges, Hayek, Salim M., Wang, Zhen, Eldrige, Jason S., Qu, Wenchun, Rosenow, Joshua M., Falowski, Steven M., Neuman, Stephanie A., Moeschler, Susan M., Wassef, Catherine, Kim, Christopher, Niazi, Tariq, Saifullah, Taher, Yee, Brian, Kim, Chong, Oryhan, Christine L., Warren, Daniel T., Lerman, Imanuel, Mora, Ruben, Hanes, Michael, Simopoulos, Thomas, Sharma, Sanjiv, Gilligan, Chris, Grace, Warren, Ade, Timothy, Mekhail, Nagy A., Hunter, John P., Choi, Daniel, and Choi, Deborah Y.

Published
2017
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23. 139 Durable Pain Relief With 10 kHz Spinal Cord Stimulation for Patients With Refractory Back Pain Who are not Surgical Candidates

Author

Patel, Naresh P., primary, Kapural, Leonardo, additional, Jameson, Jessica, additional, Johnson, Curtis, additional, Calodney, Aaron K., additional, Kosek, Peter, additional, Pilitsis, Julie G., additional, Bendel, Markus A., additional, Petersen, Erika A., additional, Wu, Chengyuan, additional, Cherry, Taissa, additional, Lad, Nandan P., additional, Yu, Cong, additional, Sayed, Dawood, additional, Goree, Johnathan, additional, Lyons, Mark K., additional, Sack, Andrew, additional, Bruce, Diana, additional, Rubenstein, Frances, additional, Province-Azalde, Rose, additional, and Caraway, David, additional

Published
2023
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24. Durable Responses at 24 Months With High-Frequency Spinal Cord Stimulation for Nonsurgical Refractory Back Pain

Author

Patel, Naresh P., Jameson, Jessica, Johnson, Curtis, Kloster, Daniel, Calodney, Aaron, Kosek, Peter, Pilitsis, Julie, Bendel, Markus, Petersen, Erika, Wu, Chengyuan, Cherry, Taissa, Lad, Shivanand, Yu, Cong, Sayed, Dawood, Goree, Johnathan, Lyons, Mark K., Sack, Andrew, Bruce, Diana, Bharara, Manish, Province-Azalde, Rose, Caraway, David, Kapural, Leonardo, Patel, Naresh P., Jameson, Jessica, Johnson, Curtis, Kloster, Daniel, Calodney, Aaron, Kosek, Peter, Pilitsis, Julie, Bendel, Markus, Petersen, Erika, Wu, Chengyuan, Cherry, Taissa, Lad, Shivanand, Yu, Cong, Sayed, Dawood, Goree, Johnathan, Lyons, Mark K., Sack, Andrew, Bruce, Diana, Bharara, Manish, Province-Azalde, Rose, Caraway, David, and Kapural, Leonardo

Abstract

OBJECTIVE: The objective of this study was to evaluate the 24-month durability of pain relief, function, quality of life, and safety outcomes for patients with nonsurgical refractory back pain (NSRBP) treated with high-frequency spinal cord stimulation (SCS) within a large, national, multicenter randomized controlled trial (RCT). METHODS: Following the completion of an RCT comparing high-frequency SCS plus CMM with CMM alone for the treatment of NSRBP, patients gave additional consent for a follow-up extension to 24 months. Presented is the cohort analysis of all patients treated with high-frequency SCS following the optional crossover at 6 months. The outcomes assessed to 24 months included responder rate of ≥ 50% pain relief measured according to the visual analog scale [VAS]), disability (Oswestry Disability Index [ODI]), quality of life (EQ-5D 5-level [EQ-5D-5L]), opioid reduction. RESULTS: Of the 125 patients who received a permanent implant, 121 completed the 12-month follow-up, 101 gave additional consent for extended follow-up, and 98 completed the 24-month follow-up. At 24 months after implantation, the mean back pain VAS score was reduced by 73% and the responder rate was 82%. ODI and EQ-5D-5L both improved by at least double the minimal clinically important difference for each measure. No unexpected adverse events were observed, and the rates of serious adverse events (3.4%) and device explantations (4.8%) were low. CONCLUSIONS: The addition of high-frequency SCS to CMM in patients with NSRBP offers profound improvements at 24 months in pain, function, quality of life, and reduced opioid use. This study provides much-needed evidence to inform current clinical practice for managing patients with NSRBP.

Published
2023

25. O070 / #895 DURABILITY OF 10KHZ SPINAL CORD STIMULATION FOR TREATING NON-SURGICAL REFRACTORY BACK PAIN: 18-MONTH OUTCOMES

Author

Kapural, Leonardo, primary, Jameson, Jessica, additional, Johnson, Curtis, additional, Kloster, Daniel, additional, Calodney, Aaron, additional, Kosek, Peter, additional, Pilitsis, Julie, additional, Bendel, Markus, additional, Petersen, Erika, additional, Wu, Chengyuan, additional, Cherry, Taissa, additional, Lad, Shivanand, additional, Yu, Cong, additional, Sayed, Dawood, additional, Goree, Jonathan, additional, Lyons, Mark, additional, Sacks, Andrew, additional, Bruce, Diana, additional, Rubenstein, Frances, additional, Azalde, Rose, additional, Caraway, David, additional, and Patel, Naresh, additional

Published
2022
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26. Treatment of nonsurgical refractory back pain with high-frequency spinal cord stimulation at 10 kHz: 12-month results of a pragmatic, multicenter, randomized controlled trial

Author

Kapural, Leonardo, primary, Jameson, Jessica, additional, Johnson, Curtis, additional, Kloster, Daniel, additional, Calodney, Aaron, additional, Kosek, Peter, additional, Pilitsis, Julie, additional, Bendel, Markus, additional, Petersen, Erika, additional, Wu, Chengyuan, additional, Cherry, Taissa, additional, Lad, Shivanand P., additional, Yu, Cong, additional, Sayed, Dawood, additional, Goree, Johnathan, additional, Lyons, Mark K., additional, Sack, Andrew, additional, Bruce, Diana, additional, Rubenstein, Frances, additional, Province-Azalde, Rose, additional, Caraway, David, additional, and Patel, Naresh P., additional

Published
2022
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27. Imaging

Author

Bendel, Markus A., primary, Trainor, Drew M., additional, and Moeschler, Susan M., additional

Published
2017
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30. ID:16541 Cost-Effectiveness of 10kHz Spinal Cord Stimulation for the Treatment of Nonsurgical Refractory Back Pain

Author

Patel, Naresh, primary, Wu, Chengyuan, additional, Lad, Shivanand, additional, Jameson, Jessica, additional, Kosek, Peter, additional, Waldorff, Erik, additional, Shum, Laura, additional, Johnson, Curtis, additional, Kloster, Daniel, additional, Calodney, Aaron, additional, Pilitsis, Julie, additional, Bendel, Markus, additional, Petersen, Erika, additional, Cherry, Taissa, additional, Yu, Cong, additional, Sayed, Dawood, additional, Rubenstein, Frances, additional, Province-Azalde, Rose, additional, Caraway, David, additional, and Kapural, Leonardo, additional

Published
2022
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32. ID:16007 Spinal Cord Stimulation at 10kHz for Non-Surgical Refractory Back Pain: Multicenter RCT Six-Month Results

Author

Calodney, Aaron, primary, Jameson, Jessica, additional, Patel, Naresh, additional, Johnson, Curtis, additional, Nalamachu, Srinivas, additional, Kosek, Peter, additional, Pilitsis, Julie, additional, Bendel, Markus, additional, Province-Azalde, Rose, additional, Caraway, David, additional, Petersen, Erika, additional, Lad, Shivanand, additional, Wu, Chengyuan, additional, Cherry, Taissa, additional, Yu, Cong, additional, Sayed, Dawood, additional, Kloster, Daniel, additional, and Kapural, Leonardo, additional

Published
2022
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34. Treatment of nonsurgical refractory back pain with high-frequency spinal cord stimulation at 10 kHz: 12-month results of a pragmatic, multicenter, randomized controlled trial.

Author

Kapural, Leonardo, Jameson, Jessica, Johnson, Curtis, Kloster, Daniel, Calodney, Aaron, Kosek, Peter, Pilitsis, Julie, Bendel, Markus, Petersen, Erika, Wu, Chengyuan, Cherry, Taissa, Lad, Shivanand P, Yu, Cong, Sayed, Dawood, Goree, Johnathan, Lyons, Mark K, Sack, Andrew, Bruce, Diana, Rubenstein, Frances, Province-Azalde, Rose, Caraway, David, Patel, Naresh P, Kapural, Leonardo, Jameson, Jessica, Johnson, Curtis, Kloster, Daniel, Calodney, Aaron, Kosek, Peter, Pilitsis, Julie, Bendel, Markus, Petersen, Erika, Wu, Chengyuan, Cherry, Taissa, Lad, Shivanand P, Yu, Cong, Sayed, Dawood, Goree, Johnathan, Lyons, Mark K, Sack, Andrew, Bruce, Diana, Rubenstein, Frances, Province-Azalde, Rose, Caraway, David, and Patel, Naresh P

Abstract

Objective: Spinal cord stimulation (SCS) at 10 kHz (10-kHz SCS) is a safe and effective therapy for treatment of chronic low-back pain. However, it is unclear from existing evidence whether these findings can be generalized to patients with chronic back pain that is refractory to conventional medical management (CMM) and who have no history of spine surgery and are not acceptable candidates for spine surgery. The authors have termed this condition "nonsurgical refractory back pain" (NSRBP) and conducted a multicenter, randomized controlled trial to compare CMM with and without 10-kHz SCS in this population. Methods: Patients with NSRBP, as defined above and with a spine surgeon consultation required for confirmation, were randomized 1:1 to patients undergoing CMM with and without 10-kHz SCS. CMM included nonsurgical treatment for back pain, according to physicians' best practices and clinical guidelines. Primary and secondary endpoints included the responder rate (≥ 50% pain relief), disability (Oswestry Disability Index [ODI]), global impression of change, quality of life (EQ-5D-5L), and change in daily opioid use and were analyzed 3 and 6 months after randomization. The protocol allowed for an optional crossover at 6 months for both arms, with observational follow-up over 12 months. Results: In total, 159 patients were randomized; 76 received CMM, and 69 (83.1%) of the 83 patients who were assigned to the 10-kHz SCS group received a permanent implant. At the 3-month follow-up, 80.9% of patients who received stimulation and 1.3% of those who received CMM were found to be study responders (primary outcome, ≥ 50% pain relief; p < 0.001). There was also a significant difference between the treatment groups in all secondary outcomes at 6 months (p < 0.001). In the 10-kHz SCS arm, outcomes were sustained, including a mean 10-cm visual analog scale score of 2.1 ± 2.3 and 2.1 ± 2.2 and mean ODI score of 24.1 ± 16.1 and 24.0 ± 17.0 at 6 and 12 months, respectively (p = 0.9

Published
2022

37. Preoperative hemoglobin A1c and perioperative blood glucose in patients with diabetes mellitus undergoing spinal cord stimulation surgery: A literature review of surgical site infection risk.

Author

Hagedorn, Jonathan M., Bendel, Markus A., Hoelzer, Bryan C., Aiyer, Rohit, and Caraway, David

Subjects
*GLYCOSYLATED hemoglobin, *SPINAL cord, *PREOPERATIVE period, *BLOOD sugar, *DIABETES, *SURGICAL site infections, *LITERATURE reviews, *NEURAL stimulation, *DISEASE risk factors
Abstract

Aims: The aim of our study was to review the surgical literature regarding the relationship between hemoglobin A1c (HbA1c), diagnosis of diabetes mellitus (DM), and risk of postoperative surgical site infection (SSI). Methods: A librarian‐assisted literature search was performed with two goals: (1) identify surgical publications related to SSI and HbA1c values, and (2) identify publications reporting infection risk with DM in spinal cord stimulation (SCS), intrathecal drug delivery systems (IDDS), and cardiovascular implantable electronic device (CIED) implantation surgeries. Published guidelines on perioperative management of DM are reviewed. Results: We identified 30 studies reporting SSI and HbA1c values. The literature review indicated that for many surgical procedures, elevated HbA1c is not correlated to rate of SSI. We identified 16 studies reporting infection rates within DM cohorts following SCS, IDDS, and CIED implantation surgeries. The data reviewed did not indicate DM as an independent risk factor for SSI. Conclusion: Preoperative HbA1c levels in patients with a history of DM is not a singularly sufficient tool to estimate risk of perioperative infection in SCS implantation surgery. Published guidelines on perioperative management of DM do not suggest a specific HbA1c above which surgery should be delayed; intentional perioperative glycemic control is recommended. [ABSTRACT FROM AUTHOR]

Published
2023
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41. Antibacterial Envelope Use for the Prevention of Surgical Site Infection in Spinal Cord Stimulator Implantation Surgery: A Retrospective Review of 52 Cases

Author

Hagedorn,Jonathan M, Canzanello,Nicholas, Bendel,Markus A, Pittelkow,Thomas P, Lamer,Tim J, Hagedorn,Jonathan M, Canzanello,Nicholas, Bendel,Markus A, Pittelkow,Thomas P, and Lamer,Tim J

Abstract

Jonathan M Hagedorn, Nicholas Canzanello, Markus A Bendel, Thomas P Pittelkow, Tim J Lamer Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, 55905, USACorrespondence: Jonathan M HagedornDepartment of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, 55905, USAFax +1 507-266-7732Email jonhagedornmd@yahoo.comObjective: Surgical site infection in patients who undergo spinal cord stimulator implant surgery represents a significant concern in terms of increased health care costs and patient morbidity. The use of antibacterial envelopes in spinal cord stimulator implant surgeries has not been previously described. The aim of this retrospective review was to evaluate the effectiveness of the antibacterial envelope in reducing surgical site infection in spinal cord stimulator implant surgeries when used adjunctively to standard infection prevention measures.Materials and Methods: The study included 52 patients, all of whom were implanted with a spinal cord stimulator between January 2015 and November 2020. To be included, patients were required to have had an antibacterial envelope utilized at the time of surgery. Patient records were retrospectively reviewed. All patients who received an antibacterial envelope at the time of implant surgery were included.Results: Data was collected and analyzed on 52 permanent SCS implantations, including primary implantation (n=26) and revision surgery (n=26). All patients were at least three months post-operative from the implant surgery (average follow-up time period was 518.4 days). There were no surgical site infections reported in the 52 patient cohort.Conclusion: Antibiotic impregnated envelopes appear to be a safe and effective modality to decrease surgical site infection risk in spinal cord stimulation implant surgeries.Keywords: spinal cord stimulation, surgical site infection, outcomes, infection prevention

Published
2021

43. ID: 218207 10kHz Spinal Cord Stimulation for Non-Surgical Refractory Back Pain: Objective Functional Outcome to 24-Months

Author

Kapural, Leonardo, Jameson, Jessica, Patel, Naresh, Johnson, Curtis, Kloster, Daniel, Calodney, Aaron, Kosek, Peter, Pilitsis, Julie, Bendel, Markus, Petersen, Erika, Wu, Chengyuan, Cherry, Taissa, Lad, Nandan, Yu, Cong, Sayed, Dawood, Goree, Johnathan, Lyons, Mark, Sacks, Andrew, Bruce, Diana, Province-Azalde, Rose, and Caraway, David

Published
2023
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47. Corrigendum to: A Systematic Literature Review of Spine Neurostimulation Therapies for the Treatment of Pain

Author

Deer, Timothy R, primary, Grider, Jay S, additional, Lamer, Tim J, additional, Pope, Jason E, additional, Falowski, Steven, additional, Hunter, Corey W, additional, Provenzano, David A, additional, Slavin, Konstantin V, additional, Russo, Marc, additional, Carayannopoulos, Alexios, additional, Shah, Jay M, additional, Harned, Michael E, additional, Hagedorn, Jonathan M, additional, Bolash, Robert B, additional, Arle, Jeff E, additional, Kapural, Leo, additional, Amirdelfan, Kasra, additional, Jain, Sameer, additional, Liem, Liong, additional, Carlson, Jonathan D, additional, Malinowski, Mark N, additional, Bendel, Markus, additional, Yang, Ajax, additional, Aiyer, Rohit, additional, Valimahomed, Ali, additional, Antony, Ajay, additional, Craig, Justin, additional, Fishman, Michael A, additional, Al-Kaisy, Adnan A, additional, Christelis, Nick, additional, Rosenquist, Richard W, additional, Levy, Robert M, additional, and Mekhail, Nagy, additional

Published
2020
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48. A Systematic Literature Review of Spine Neurostimulation Therapies for the Treatment of Pain

Author

Deer, Timothy R, primary, Grider, Jay S, primary, Lamer, Tim J, primary, Pope, Jason E, primary, Falowski, Steven, primary, Hunter, Corey W, primary, Provenzano, David A, primary, Slavin, Konstantin V, primary, Russo, Marc, primary, Carayannopoulos, Alexios, primary, Shah, Jay M, primary, Harned, Michael E, primary, Hagedorn, Jonathan M, primary, Bolash, Robert B, primary, Arle, Jeff E, primary, Kapural, Leo, primary, Amirdelfan, Kasra, primary, Jain, Sameer, primary, Liem, Liong, primary, Carlson, Jonathan D, primary, Malinowski, Mark N, primary, Bendel, Markus, primary, Yang, Ajax, primary, Aiyer, Rohit, primary, Valimahomed, Ali, primary, Antony, Ajay, primary, Craig, Justin, primary, Fishman, Michael A, primary, Al-Kaisy, Adnan A, primary, Christelis, Nick, primary, Rosenquist, Richard W, primary, Levy, Robert M, primary, and Mekhail, Nagy, primary

Published
2020
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49. Delayed Cutaneous Fluid Leakage after Fluoroscopic-Guided Epidural Steroid Injection.

Author

D'Souza, Ryan S, Woods, Charonn D, Lee, Daewoong, Kissoon, Narayan, and Bendel, Markus

Subjects
CEREBROSPINAL fluid otorrhea, ECHOCARDIOGRAPHY, FUROSEMIDE, TRANSFERRIN, CEREBROSPINAL fluid rhinorrhea, STEROIDS, SURGICAL complications, MAGNETIC resonance imaging, FLUOROSCOPY, EPIDURAL injections, COMPUTED tomography, PEPTIDE hormones, EDEMA
Abstract

A case study of 71-year-old male with a history of congestive heart failure, atrial fibrillation anti-coagulated on warfarin, peripheral arterial disease, moderate lumbar spinal stenosis, and bilateral symmetrical lower extremity pain and low back pain presented to the pain clinic for interventional pain treatment options.

Published
2021
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50. The effect of spinal cord stimulation on pain medication reduction in intractable spine and limb pain: a systematic review of randomized controlled trials and meta-analysis

Author

Pollard,E. Morgan, Lamer,Tim J, Moeschler,Susan M, Gazelka,Halena M., Hooten,W. Michael, Bendel,Markus A., Warner,Nafisseh S., and Murad,Hassan

Subjects
Journal of Pain Research
Abstract

E Morgan Pollard,1 Tim J Lamer,2 Susan M Moeschler,3 Halena M Gazelka,3 W Michael Hooten,3 Markus A Bendel,3 Nafisseh S Warner,3 M Hassan Murad41Division of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA; 2Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA; 3Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; 4Preventive, Occupational, and Aerospace Medicine, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USAObjective: To synthesize the evidence regarding the effect of spinal cord stimulation (SCS) on opioid and pain medication reduction in patients with intractable spine or limb pain.Methods: A comprehensive literature search was conducted to identify RCTs of patients with chronic back and/or limb pain of greater than one year duration. Only comparative studies were included (ie, conventional SCS vs medical therapy, conventional SCS vs high-frequency SCS) and were required to have a minimum follow-up period of 3 months. Random effect meta-an alysis was used to compare the three interventions. Results were expressed as odds ratio (OR) or weighted mean difference (WMD) with 95% confidence intervals (CI).Results: We identified five trials enrolling 489 patients. Three of the trials reported the results as a number of patients who were able to reduce or eliminate opioid consumption in the SCS vs medical therapy group. The odds of reducing opioid consumption were significantly increased in the SCS group compared to medical therapy (OR 8.60, CI {1.93–38.30}). Two of the trials reported the results as mean medication dose reduction as measured by the Medication Quantification Scale (MQS) in the SCS group vs medical therapy group. MQS score significantly decreased in the SCS group and not in the medical group (WMD –1.97, 95% CI {–3.67, –0.27}). One trial reported a number of patients in high-frequency SCS who were able to reduce opioids vs number of patients in conventional SCS group who were able to reduce opioids. Thirty-four percent of the patients in the high-frequency group and 26% of the patients in the conventional SCS group were able to reduce opioid consumption; however, there was not a significant difference between groups (OR 1.43, 95% CI {0.74, 2.78}). This trial also quantified the opioid reduction in morphine equivalent dosage (MED). In the high-frequency SCS group, average MED decreased by 24.8 mg vs average MED decrease of 7.3 mg in the conventional SCS group. Again, the difference between groups did not reach statistical significance (–17.50, CI {–66.27, 31.27}).Conclusions: In patients with intractable spine/limb pain, SCS was associated with increased odds of reducing pain medication consumption. However, results should be treated with caution as available data were limited, and clinical significance of these findings requires further study.Keywords: spinal cord stimulation, chronic back pain, painful diabetic neuropathy, chronic limb pain, high-frequency spinal stimulations, opioids, pain medications

Published
2019

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