scholarly journals Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 193-201
Author(s):  
Syed M Adil ◽  
Lefko T Charalambous ◽  
Charis A Spears ◽  
Musa Kiyani ◽  
Sarah E Hodges ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Dose Reduction ◽  
Spinal Cord Stimulation ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Patient Centered ◽  
Opioid Dose ◽  
The Impact

Abstract BACKGROUND Opioid misuse in the USA is an epidemic. Utilization of neuromodulation for refractory chronic pain may reduce opioid-related morbidity and mortality, and associated economic costs. OBJECTIVE To assess the impact of spinal cord stimulation (SCS) on opioid dose reduction. METHODS The IBM MarketScan® database was retrospectively queried for all US patients with a chronic pain diagnosis undergoing SCS between 2010 and 2015. Opioid usage before and after the procedure was quantified as morphine milligram equivalents (MME). RESULTS A total of 8497 adult patients undergoing SCS were included. Within 1 yr of the procedure, 60.4% had some reduction in their opioid use, 34.2% moved to a clinically important lower dosage group, and 17.0% weaned off opioids entirely. The proportion of patients who completely weaned off opioids increased with decreasing preprocedure dose, ranging from 5.1% in the >90 MME group to 34.2% in the ≤20 MME group. The following variables were associated with reduced odds of weaning off opioids post procedure: long-term opioid use (odds ratio [OR]: 0.26; 95% CI: 0.21-0.30; P < .001), use of other pain medications (OR: 0.75; 95% CI: 0.65-0.87; P < .001), and obesity (OR: 0.75; 95% CI: 0.60-0.94; P = .01). CONCLUSION Patients undergoing SCS were able to reduce opioid usage. Given the potential to reduce the risks of long-term opioid therapy, this study lays the groundwork for efforts that may ultimately push stakeholders to reduce payment and policy barriers to SCS as part of an evidence-based, patient-centered approach to nonopioid solutions for chronic pain.

scholarly journals A Brief Screening Tool for Opioid Use Disorder: EMPOWER Study Expert Consensus Protocol

2021 ◽  
Vol 8 ◽  
Author(s):  
Dokyoung S. You ◽  
Aram S. Mardian ◽  
Beth D. Darnall ◽  
Chwen-Yuen A. Chen ◽  
Korina De Bruyne ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Screening Tool ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Consensus Protocol ◽  
Patient Centered ◽  
Treatment Pathways ◽  
Opioid Tapering

Growing concerns about the safety of long-term opioid therapy and its uncertain efficacy for non-cancer pain have led to relatively rapid opioid deprescribing in chronic pain patients who have been taking opioid for years. To date, empirically supported processes for safe and effective opioid tapering are lacking. Opioid tapering programs have shown high rates of dropouts and increases in patient distress and suicidal ideation. Therefore, safe strategies for opioid deprescribing that are more likely to succeed are urgently needed. In response to this demand, the EMPOWER study has been launched to examine the effectiveness of behavioral medicine strategies within the context of patient-centered opioid tapering in outpatient settings (https://empower.stanford.edu/). The EMPOWER protocol requires an efficient process for ensuring that collaborative opioid tapering would be offered to the most appropriate patients while identifying patients who should be offered alternate treatment pathways. As a first step, clinicians need a screening tool to identify patients with Opioid Use Disorder (OUD) and to assess for OUD severity. Because such a tool is not available, the study team composed of eight chronic pain and/or addiction experts has extended a validated screening instrument to develop a brief and novel consensus screening tool to identify OUD and assess for OUD severity for treatment stratification. Our screening tool has the potential to assist busy outpatient clinicians to assess OUD among patients receiving long-term opioid therapy for chronic pain.

Retrospective analysis on the effect of spinal cord stimulation on opioid consumption

2020 ◽  
Author(s):  
Awinita Barpujari ◽  
Michael A Erdek
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Retrospective Analysis ◽  
Spinal Cord Stimulation ◽  
Alternative Therapy ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Number Of Patients ◽  
Chronic Pain Conditions ◽  
Post Trial

Aim: Spinal cord stimulation (SCS) is used to clinically manage and/or treat several chronic pain etiologies. A limited amount is known about the influence on patients' use of opioid pain medication. This retrospective analysis evaluated SCS effect on opioid consumption in patients presenting with chronic pain conditions. Materials & methods: Sixty-seven patients underwent a temporary trial device, permanent implant or both. Patients were divided for assessment based on the nature of their procedure(s). Primary outcome was change in morphine equivalent dose (MED), ascertained from preoperative and postoperative medication reports. Results: Postoperative MED was significantly lower in patients who received some form of neuromodulation therapy. Pretrial patients reported an average MED of 41.01 ± 10.23 mg per day while post-trial patients reported an average of 13.30 ± 5.34 mg per day (p < 0.001). Pre-implant patients reported an average MED of 39.14 ± 13.52 mg per day while post-implant patients reported an average MED of 20.23 ± 9.01 mg per day (p < 0.001). There were no significant differences between pre-trial and pre-implant MED, nor between post-trial and post-implant MED. Of the 42 study subjects who reported some amount of pre-intervention opioid use, 78.57% indicated a lower MED (n = 33; p < 0.001), 16.67% indicated no change (n = 7) and 4.76% (n = 2) indicated a higher MED, following intervention. Moreover, SCS therapy resulted in a 26.83% reduction (p < 0.001) in the number of patients with MED >50 mg per day. Conclusion: Spinal cord stimulation may reduce opioid use when implemented appropriately. Neuromodulation may represent alternative therapy for alleviating chronic pain which may avoid a number of deleterious side effects commonly associated with opioid consumption.

scholarly journals Deep Learning Versus Logistic Regression to Predict Opioid Dose Reduction After Spinal Cord Stimulation

Neurosurgery ◽  
2020 ◽  
Vol 67 (Supplement_1) ◽  
Author(s):  
Syed M Adil ◽  
Lefko T Charalambous ◽  
Kelly R Murphy ◽  
Shervin Rahimpour ◽  
Stephen C Harward ◽  
...  
Keyword(s):  
Neural Network ◽  
Spinal Cord ◽  
Deep Learning ◽  
Dose Reduction ◽  
Spinal Cord Stimulation ◽  
Network Architecture ◽  
Characteristic Curve ◽  
Model Performance ◽  
Health Crisis ◽  
Opioid Dose

Abstract INTRODUCTION Opioid misuse persists as a public health crisis affecting approximately one in four Americans.1 Spinal cord stimulation (SCS) is a neuromodulation strategy to treat chronic pain, with one goal being decreased opioid consumption. Accurate prognostication about SCS success is key in optimizing surgical decision making for both physicians and patients. Deep learning, using neural network models such as the multilayer perceptron (MLP), enables accurate prediction of non-linear patterns and has widespread applications in healthcare. METHODS The IBM MarketScan® (IBM) database was queried for all patients ≥ 18 years old undergoing SCS from January 2010 to December 2015. Patients were categorized into opioid dose groups as follows: No Use, ≤ 20 morphine milligram equivalents (MME), 20–50 MME, 50–90 MME, and &gt;90 MME. We defined “opiate weaning” as moving into a lower opioid dose group (or remaining in the No Use group) during the 12 months following permanent SCS implantation. After pre-processing, there were 62 predictors spanning demographics, comorbidities, and pain medication history. We compared an MLP with four hidden layers to the LR model with L1 regularization. Model performance was assessed using area under the receiver operating characteristic curve (AUC) with 5-fold nested cross-validation. RESULTS Ultimately, 6,124 patients were included, of which 77% had used opioids for &gt;90 days within the 1-year pre-SCS and 72% had used &gt;5 types of medications during the 90 days prior to SCS. The mean age was 56 ± 13 years old. Collectively, 2,037 (33%) patients experienced opiate weaning. The AUC was 0.74 for the MLP and 0.73 for the LR model. CONCLUSION To our knowledge, we present the first use of deep learning to predict opioid weaning after SCS. Model performance was slightly better than regularized LR. Future efforts should focus on optimization of neural network architecture and hyperparameters to further improve model performance. Models should also be calibrated and externally validated on an independent dataset. Ultimately, such tools may assist both physicians and patients in predicting opioid dose reduction after SCS.

scholarly journals Benefits and Harms of Long-term Opioid Dose Reduction or Discontinuation in Patients with Chronic Pain: a Rapid Review

2020 ◽  
Vol 35 (S3) ◽  
pp. 935-944 ◽  
Author(s):  
Katherine Mackey ◽  
Johanna Anderson ◽  
Donald Bourne ◽  
Emilie Chen ◽  
Kim Peterson
Keyword(s):  
Chronic Pain ◽  
Dose Reduction ◽  
Rapid Review ◽  
Opioid Dose

Long-term effects of spinal cord stimulation in chronic pain syndromes

1986 ◽  
Vol 233 (1) ◽  
pp. 16-18 ◽  
Author(s):  
H. P. Vogel ◽  
B. Heppner ◽  
N. H�mbs ◽  
J. Schramm ◽  
C. Wagner
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Long Term Effects ◽  
Pain Syndromes ◽  
Chronic Pain Syndromes

A Two-Year Prospective Multicenter Study of Opioid Therapy for Chronic Noncancer Pain: Prescription Trends and Predictors

Pain Medicine ◽  
2018 ◽  
Vol 20 (11) ◽  
pp. 2166-2178 ◽  
Author(s):  
Dalila R Veiga ◽  
Liliane Mendonça ◽  
Rute Sampaio ◽  
José M Castro-Lopes ◽  
Luís F Azevedo
Keyword(s):  
Chronic Pain ◽  
Clinical Outcomes ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain ◽  
Opioid Users

Abstract Objectives Opioid use in chronic pain has increased worldwide in recent years. The aims of this study were to describe the trends and patterns of opioid therapy over two years of follow-up in a cohort of chronic noncancer pain (CNCP) patients and to assess predictors of long-term opioid use and clinical outcomes. Methods A prospective cohort study with two years of follow-up was undertaken in four multidisciplinary chronic pain clinics. Demographic data, pain characteristics, and opioid prescriptions were recorded at baseline, three, six, 12, and 24 months. Results Six hundred seventy-four CNCP patients were recruited. The prevalence of opioid prescriptions at baseline was 59.6% (N = 402), and 13% (N = 86) were strong opioid prescriptions. At 24 months, opioid prescription prevalence was as high as 74.3% (N = 501), and strong opioid prescription was 31% (N = 207). Most opioid users (71%, N = 479) maintained their prescription during the two years of follow-up. Our opioid discontinuation was very low (1%, N = 5). Opioid users reported higher severity and interference pain scores, both at baseline and after two years of follow-up. Opioid use was independently associated with continuous pain, pain location in the lower limbs, and higher pain interference scores. Conclusions This study describes a pattern of increasing opioid prescription in chronic pain patients. Despite the limited improvement of clinical outcomes, most patients keep their long-term opioid prescriptions. Our results underscore the need for changes in clinical practice and further research into the effectiveness and safety of chronic opioid therapy for CNPC.

scholarly journals Race and Gender Are Associated with Opioid Dose Reduction Among Patients on Chronic Opioid Therapy

Pain Medicine ◽  
2018 ◽  
Vol 20 (8) ◽  
pp. 1519-1527 ◽  
Author(s):  
Michele Buonora ◽  
Hector R Perez ◽  
Moonseong Heo ◽  
Chinazo O Cunningham ◽  
Joanna L Starrels
Keyword(s):  
Dose Reduction ◽  
Clinical Decision Making ◽  
Female Gender ◽  
Opioid Therapy ◽  
Clinical Factors ◽  
Opioid Use ◽  
Chronic Opioid Therapy ◽  
Race And Gender ◽  
Opioid Dose ◽  
And Gender

Abstract Objective Among patients with chronic pain, risk of opioid use is elevated with high opioid dose or concurrent benzodiazepine use. This study examined whether these clinical factors, or sociodemographic factors of race and gender, are associated with opioid dose reduction. Design and Setting A retrospective cohort study of outpatients prescribed chronic opioid therapy between 2007 and 2012 within a large, academic health care system in Bronx, New York, using electronic medical record data. Included patients were prescribed a stable dose of chronic opioid therapy over a one-year “baseline period” and did not have cancer. Methods The primary outcome was opioid dose reduction (≥30% reduction from baseline) within two years. Multivariable logistic regression tested the associations of two clinical variables (baseline daily opioid dose and concurrent benzodiazepine prescription) and two sociodemographic variables (race/ethnicity and gender) with opioid dose reduction. Results Of 1,097 patients, 463 (42.2%) had opioid dose reduction. High opioid dose (≥100 morphine-milligram equivalents [MME]) was associated with lower odds of opioid dose reduction compared with an opioid dose <100 MME (adjusted odds ratio [AOR] = 0.69, 95% confidence interval [CI] = 0.54–0.89). Concurrent benzodiazepine prescription was not associated with opioid dose reduction. Black (vs white) race and female (vs male) gender were associated with greater odds of opioid dose reduction (AOR = 1.82, 95% CI = 1.22–2.70; and AOR = 1.43, 95% CI = 1.11–1.83, respectively). Conclusions Black race and female gender were associated with greater odds of opioid dose reduction, whereas clinical factors of high opioid dose and concurrent benzodiazepine prescription were not. Efforts to reduce opioid dose should target patients based on clinical factors and address potential biases in clinical decision-making.

Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review

2004 ◽  
Vol 100 (3) ◽  
pp. 254-267 ◽  
Author(s):  
Tracy Cameron
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Literature Review ◽  
Spinal Cord Stimulation ◽  
Exclusion Criteria ◽  
Safety And Efficacy ◽  
Content Type ◽  
Long Term Effect ◽  
Fine Print

Object. The purpose of this report was to examine the available literature to determine the safety and efficacy of spinal cord stimulation (SCS) for the treatment of chronic pain of the trunk and limbs. Methods. The author identified 68 studies that fulfilled the efficacy inclusion/exclusion criteria, grouped on the basis of pain indication, with an overall population of 3679 patients. Fifty-one studies fulfilled all safety inclusion/exclusion criteria. Based on the literature review, the author found that SCS had a positive, symptomatic, long-term effect in cases of refractory angina pain, severe ischemic limb pain secondary to peripheral vascular disease, peripheral neuropathic pain, and chronic low-back pain, and that, in general, SCS was a safe and effective treatment for a variety of chronic neuropathic conditions. Conclusions. Despite the positive findings, there is an urgent need for randomized, controlled, long-term studies on the efficacy of SCS involving larger patient sample sizes.

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