Spinal Cord Stimulation Improves Quality of Life for Patients With Chronic Pain-Data From the UK and Ireland National Neuromodulation Registry.

Introduction: Spinal cord stimulation (SCS) is a well-established treatment for chronic pain and is supported by numerous studies. However, some recent articles have questioned its efficacy. This article examines a cohort of >1800 patients with SCS from the UK and Ireland National Neuromodulation Registry. It is intended to provide a "real-world" assessment of efficacy and compare its effects with other procedures performed for painful indications.
Materials and Methods: Quality of life (QoL) data (EuroQoL five-level [EQ5D]) and demographic data were extracted from the National Neuromodulation Registry for all patients (N = 1811) who underwent SCS for chronic pain in 27 centers in the UK between February 2018 and July 2022. These were compared with data from the published literature for other commonly performed elective surgical procedures.
Results: The EQ5D utility index increased by a mean of 0.202 in the 1236 patients with paired pre- and postoperative utility scores. The median utility was 0.263 (interquartile range [IQR] = 0.384; n = 1811) preoperatively, whereas at six months after the operation, it was 0.550 (IQR = 0.396; n = 1025), p < 0.0001, Wilcoxon rank sum test. The median utility score at 12 months postoperation was 0.548 (IQR = 0.417; n = 970). There was no difference in utility scores at six months and 12 months after implantation (p = 0.15, Wilcoxon rank sum test). There was a significant improvement in QoL in all five domains of the five-level EQ5D tool at six months after baseline (p < 0.01, for all subcategories), and this was sustained at one year after implantation. The baseline utility was lower than in patients who underwent elective surgery for other painful conditions, and the absolute (and proportionate) increase in utility produced by SCS was greater than that achieved with most other interventions.
Conclusions: SCS increases the QoL in patients requiring surgery for pain. Similar results were seen regardless of SCS indication. When comparing analogous data bases, SCS produces a greater percentage improvement in EQ5D utility than do many other elective surgical procedures for painful conditions, including spinal surgery and some joint replacements.
Competing Interests: Conflict of Interest Ganesan Baranidharan has received consulting fees from Abbott, Boston Scientific, Medtronic, and Saluda Medical; has received honoraria from Abbott, Boston Scientific, Mainstay Medical, Saluda Medical, Stryker, and Nevro Corp; and sits on the international data safety board for Saluda Medical. Stana Bojanić sits on the board of the International Neuromodulation Society. Sam Eldabe has received departmental grants from Boston Scientific and Saluda Medical; and consulting fees from Medtronic, Saluda Medical, Mainstay Medical, and Esteve Pharmaceutical. James J. FitzGerald has received institutional research grants from Merck and UCB; consulting fees from Abbott and Lilly; educational honoraria from Abbott; and advisory board fees from Medtronic and Abbott. Sarah Love-Jones has received travel honoraria from Boston Scientific, Nevro Corp, Abbott, Medtronic, and Saluda Medical; research grants from Boston Scientific, Mainstay Medical, Nevro Corp, Saluda Medical, Nalu Medical, and Abbott; and sits on the medical advisory board for Boston Scientific, Nevro Corp, Saluda Medical, Medtronic, and Pfizer. Vivek Mehta has received consulting fees from Mainstay Medical, Lundbeck, Pfizer, Boston Scientific, and Medtronic; holds an advisory position with Medtronic, Pfizer, and Man & Science; and sits on the board of the Neuromodulation Society of UK and Ireland, and the Education Committee of the North American Neuromodulation Society. Simon Thomson has received grants, honoraria, and consulting fees from Boston Scientific, Mainstay Medical, and Saluda Medical and holds an advisory position with Galvani Bioelectronics. The remaining authors report no conflict of interest.
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