Objectives

Spinal cord stimulation (SCS) can reduce the need for opioids; however, the influence on the full spectrum of pain medication is less known. The aims of this study were to explore general prescription practices for patients scheduled for SCS, potential differences in prescriptions between Belgium and United Kingdom, and the influence of SCS on pain medication.

Materials and Methods

Individual patient data from the TRIAL-STIM study in the United Kingdom and DISCOVER in Belgium were pooled. Medication use was collected before SCS and three months after SCS from 180 chronic pain patients. The Medication Quantification Scale III (MQS) was used to calculate a total score for medication use, as well as subscores for several classes. Differences in prescription practices between United Kingdom and Belgium were evaluated with two-sided Wilcoxon tests. To evaluate differences in medication use after three months of SCS between United Kingdom and Belgium, Tweedie-generalized linear models were calculated.

Results

There was a statistically significant difference (−6.40 [95% CI from −3.40 to −9.10]) between the median total MQS score in United Kingdom and Belgium before SCS. Additionally, a significant difference was found for nonsteroidal anti-inflammatory drugs (NSAIDs) (−3.40 [95% CI −3.40 to −6.80]), neuropathic agents (−2.30 [95% CI −0.40 to −3.80]), and benzodiazepines (1.83e⁻⁰⁵ [95% CI 2.64⁻⁰⁵ to 7.45⁻⁰⁵]) between United Kingdom and Belgium, before SCS. Tweedie-generalized models revealed a statistically significant interaction between country and time for MQS, neuropathic agents, and opioids.

Conclusions

Our combined analysis revealed differences in prescription practice in patients scheduled for SCS implantation between Belgium and United Kingdom. NSAIDs and neuropathic mood agents are more frequently used in the United Kingdom, presumably due to easier access to repeat prescriptions and over the counter medications. After three months of SCS, a decrease in medication use is observed in both countries, with higher reductions in Belgium, presumably due to strict regulations concerning reimbursement criteria.

中文翻译：

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脊髓刺激前后止痛药的跨国差异：来自英国和比利时两项前瞻性研究的个体患者数据的汇总分析

目标

脊髓刺激 (SCS) 可以减少对阿片类药物的需求；然而，对所有止痛药的影响却鲜为人知。本研究的目的是探讨计划接受 SCS 的患者的一般处方做法、比利时和英国处方的潜在差异以及 SCS 对止痛药的影响。

材料和方法

来自英国 TRIAL-STIM 研究和比利时 DISCOVER 研究的个体患者数据被汇集在一起​​。收集了 180 名慢性疼痛患者在 SCS 之前和 SCS 之后三个月的药物使用情况。药物量化量表 III (MQS) 用于计算药物使用的总分，以及几个类别的分项分数。英国和比利时在处方实践方面的差异通过双侧 Wilcoxon 检验进行了评估。为了评估英国和比利时三个月 SCS 后药物使用的差异，计算了 Tweedie 广义线性模型。

结果

在 SCS 之前，英国和比利时的 MQS 总分中位数之间存在统计学显着差异（-6.40 [95% CI 从 -3.40 到 -9.10]）。此外，非甾体类抗炎药 (NSAID)（-3.40 [95% CI -3.40 至 -6.80]）、神经病药物（-2.30 [95% CI -0.40 至 -3.80]）和苯二氮卓类药物存在显着差异(1.83e ^-05 [95% CI 2.64 ^-05至 7.45 ^-05 ]) 在英国和比利时之间，南海之前。Tweedie 广义模型揭示了 MQS、神经病药物和阿片类药物在国家和时间之间具有统计学意义的相互作用。

结论

我们的综合分析揭示了比利时和英国之间计划进行 SCS 植入的患者的处方实践差异。非甾体抗炎药和神经性情绪药物在英国的使用更为频繁，大概是因为更容易获得重复处方和非处方药。在 SCS 三个月后，两个国家的药物使用均有所减少，比利时的减少幅度更大，这可能是由于有关报销标准的严格规定。