Abstract

BACKGROUND

Spinal cord stimulation (SCS) is an effective treatment in failed back surgery syndrome (FBSS). The effect of neuropathic pain medication use on SCS outcome is poorly understood.

OBJECTIVE

To study the effect of gabapentinoid use on SCS outcome measured by trial success, explantation rate and opioid dose reduction during a 2-yr follow-up.

METHODS

The study cohort included 203 consecutive FBSS patients who underwent SCS in a single tertiary center during January 1997 to March 2014. Purchase data of gabapentinoids, opioids, tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors, and benzodiazepines during January 1995 to March 2016 were retrieved from national registries.

RESULTS

In multivariate Cox regression analysis, patients using gabapentinoids had significantly fewer explantations during the 2-yr follow-up (hazard ratio [HR] 0.2, 95% CI 0.04-0.81, P = .03). In contrast, patients with opioid use of >40 morphine milligram equivalent before implantation had significantly more explantations (HR 6.7, 95% CI 2.5-18, P < .01). In bivariate logistic regression analysis adjusted for patient specific factors, year of SCS implantation, use of neuropathic pain medication, opioids, and benzodiazepines, patients using gabapentinoids significantly more often discontinued opioids or reduced their dose by more than 50% during the 2-yr follow-up (odds ratio 5.7, 95% CI 1.4-23, P = .015).

CONCLUSION

The use of gabapentinoids was associated with a significantly lower spinal cord stimulator explantation rate and a higher chance of opioid discontinuation or >50% dose reduction. This indicates that patients with SCS could benefit from concomitant use of gabapentinoids. Prospective randomized trials are warranted to verify this hypothesis.

中文翻译：

---

加巴喷丁与 203 例脊髓刺激手术失败综合征患者的较低外植率相关

摘要

背景

脊髓刺激 (SCS) 是治疗背部手术失败综合征 (FBSS) 的有效方法。使用神经性止痛药对 SCS 结果的影响知之甚少。

客观的

研究加巴喷丁类药物对 SCS 结果的影响，通过试验成功、外植率和 2 年随访期间阿片类药物剂量减少来衡量。

方法

该研究队列包括 1997 年 1 月至 2014 年 3 月期间在单一三级中心接受 SCS 的 203 名连续 FBSS 患者。 检索了 1995 年 1 月至 2016 年 3 月期间加巴喷丁类、阿片类药物、三环类抗抑郁药、5-羟色胺和去甲肾上腺素再摄取抑制剂以及苯二氮卓类药物的购买数据国家登记处。

结果

在多变量 Cox 回归分析中，使用加巴喷丁类药物的患者在 2 年随访期间的外植率显着减少（风险比 [HR] 0.2，95% CI 0.04-0.81，P =  .03）。相比之下，植入前阿片类药物使用量 > 40 毫克当量的患者有明显更多的外植体（HR 6.7，95% CI 2.5-18，P <  .01）。在针对患者特定因素、SCS 植入年份、使用神经性止痛药、阿片类药物和苯二氮卓类药物进行调整的双变量逻辑回归分析中，使用加巴喷丁类药物的患者在 2 年随访期间明显更常停用阿片类药物或将其剂量减少 50% 以上向上（优势比 5.7，95% CI 1.4-23，P = .015）。

结论

加巴喷丁类药物的使用与显着降低的脊髓刺激器外植率和较高的阿片类药物停用或>50% 剂量减少的机会相关。这表明 SCS 患者可以从加巴喷丁类药物的同时使用中受益。有必要进行前瞻性随机试验来验证这一假设。