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Improving care of chronic pain patients with spinal cord stimulator therapy amidst the opioid epidemic

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Abstract

The US government and other key stakeholders including professional medical bodies have amended recommendations in recent years to emphasize using no opioids or the lowest effective dose of opioids needed for treatment of chronic pain. However, there remains an unmet need for pain treatments that can both relieve the pain of patients and reduce the doses of opioids they require. The Center for Medicare and Medicaid Services (CMS) is currently considering such treatments through the SUPPORT ACT and has recently conferred with the Health and Human Services (HHS) Inter-agency Pain Management Task Force to consider such therapies. We reviewed literature evidence in PubMed on pain relief and opioid reduction following spinal cord stimulation (SCS) treatment. SCS presents an effective non-pharmacologic pain treatment modality that has been used for decades to reduce chronic pain from trauma or neuropathy and has been shown to either stabilize or reduce opioid use in some patients with painful conditions. A more recently developed high-frequency SCS modality, 10 kHz SCS, has the advantage of being paresthesia-independent. It has been shown to be associated with significant reductions in opioid consumption after stimulation therapy was initiated, and many patients even taking high doses of opioids (> 90 mg morphine equivalent dose per day) were able to reduce their opioid intake to levels associated with less risk. The evidence shows that reduction of opioids as early in the treatment process as possible is desirable to reduce patient risk and improve pain relief from stimulation therapy.

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References

  1. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G (2018) Drug and opioid-involved overdose deaths - United States, 2013-2017. MMWR Morb Mortal Wkly Rep 67(5152):1419–1427

    Article  PubMed  PubMed Central  Google Scholar 

  2. National Safety Council (2018) Lifetime odds of dying for selected causes, United States, 2017. Available at: https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying/data-details/. Accessed August 8, 2019

  3. Dowell D, Haegerich TM, Chou R (2016) CDC guideline for prescribing opioids for chronic pain--United States, 2016. JAMA 315(15):1624–1645

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Edlund MJ, Martin BC, Russo JE, DeVries A, Braden JB, Sullivan MD (2014) The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: the role of opioid prescription. Clin J Pain 30(7):557–564

    PubMed  PubMed Central  Google Scholar 

  5. Tompkins DA, Campbell CM (2011) Opioid-induced hyperalgesia: clinically relevant or extraneous research phenomenon? Curr Pain Headache Rep 15(2):129–136

    Article  PubMed  PubMed Central  Google Scholar 

  6. Rubin R (2019) Limits on opioid prescribing leave patients with chronic pain vulnerable. JAMA 321(21):2059–2062

  7. Abbott. Spinal Column Stimulation for Chronic Pain. Available at: https://www.neuromodulation.abbott/us/en/hcp/products/spinal-column-stimulation-for-chronic-pain.html. Accessed Sep 6, 2019

  8. Boston Scientific. About Spinal Cord Stimulation. Available at: https://www.bostonscientific.com/en-US/medical-specialties/pain-medicine/about-scs.html. Accessed Sep 6, 2019

  9. Medtronic. Spinal Cord Stimulation - Indications, Safety, and Warnings. Available at: https://www.medtronic.com/us-en/healthcare-professionals/therapies-procedures/neurological/spinal-cord-stimulation/indications-safety-warnings.html#.VHymwjHF98E. Accessed Sep 6, 2019

  10. Nevro (2019) Physician Implant Manual: Senza®, Senza II™, Senza Omnia™: https://s21.q4cdn.com/478267292/files/doc_downloads/manuals/united_states/2019/Physician-Manual-(11051).pdf

  11. Song JJ, Popescu A, Bell RL (2014) Present and potential use of spinal cord stimulation to control chronic pain. Pain Physician 17(3):235–246

    PubMed  Google Scholar 

  12. Kumar K, North R, Taylor R, Sculpher M, den Abeele C, Gehring M, Jacques L, Eldabe S, Meglio M, Molet J, Thomson S, O'Callaghan J, Eisenberg E, Milbouw G, Fortini G, Richardson J, Buchser E, Tracey S, Reny P, Brookes M, Sabene S, Cano P, Banks C, Pengelly L, Adler R, Leruth S, Kelly C, Jacobs M (2005) Spinal cord stimulation vs. conventional medical management: a prospective, randomized, controlled, multicenter study of patients with failed back surgery syndrome (PROCESS study). Neuromodulation 8(4):213–218

    Article  PubMed  Google Scholar 

  13. Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, Thomson S, O’Callaghan J, Eisenberg E, Milbouw G, Buchser E, Fortini G, Richardson J, North RB (2007) Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain 132(1–2):179–188

    Article  PubMed  Google Scholar 

  14. North RB, Kidd D, Shipley J, Taylor RS (2007) Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery 61(2):361–368 discussion 368-369

    Article  PubMed  Google Scholar 

  15. North RB, Kidd DH, Farrokhi F, Piantadosi SA (2005) Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery 56(1):98–106 discussion 106-107

    Article  PubMed  Google Scholar 

  16. Kapural L, Yu C, Doust MW, Gliner BE, Vallejo R, Sitzman BT, Amirdelfan K, Morgan DM, Brown LL, Yearwood TL, Bundschu R, Burton AW, Yang T, Benyamin R, Burgher AH (2015) Novel 10-kHz high-frequency therapy (HF10 therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: the SENZA-RCT randomized controlled trial. Anesthesiology 123(4):851–860

    Article  PubMed  Google Scholar 

  17. Amirdelfan K, Yu C, Doust MW, Gliner BE, Morgan DM, Kapural L, Vallejo R, Sitzman BT, Yearwood TL, Bundschu R, Yang T, Benyamin R, Burgher AH, Brooks ES, Powell AA, Subbaroyan J (2018) Long-term quality of life improvement for chronic intractable back and leg pain patients using spinal cord stimulation: 12-month results from the SENZA-RCT. Qual Life Res 27(8):2035–2044

    Article  PubMed  Google Scholar 

  18. Amirdelfan K, Gliner BE, Kapural L et al (2019) A proposed definition of remission from chronic pain, based on retrospective evaluation of 24-month outcomes with spinal cord stimulation. Postgrad Med 131(4):278–286

  19. Dowell D, Compton WM, Giroir BP (2019) Patient-centered reduction or discontinuation of long-term opioid analgesics: the HHS guide for clinicians. JAMA 322(19):1855–1856

  20. Lad SP, Petraglia Iii FW, Kent AR et al (2016) Longer delay from chronic pain to spinal cord stimulation results in higher healthcare resource utilization. Neuromodulation 19(5):469–76

  21. Sharan AD, Riley J, Falowski S, Pope JE, Connolly AT, Karst E, Dalal N, Provenzano DA (2018) Association of opioid usage with spinal cord stimulation outcomes. Pain Med 19(4):699–707

    Article  PubMed  Google Scholar 

  22. Simopoulos T, Sharma S, Wootton RJ, Orhurhu V, Aner M, Gill JS (2019) Discontinuation of chronic opiate therapy after successful spinal cord stimulation is highly dependent upon the daily opioid dose. Pain Pract 19(8):794–799

  23. Gee L, Smith HC, Ghulam-Jelani Z, Khan H, Prusik J, Feustel PJ, McCallum SE, Pilitsis JG (2019) Spinal cord stimulation for the treatment of chronic pain reduces opioid use and results in superior clinical outcomes when used without opioids. Neurosurgery 84(1):217–226

    Article  PubMed  Google Scholar 

  24. Dougherty MC, Woodroffe RW, Wilson S, Gilles GT, Howard MA 3rd, Carnahan RM (2019) Predictors of reduced opioid use with spinal cord stimulation in patients with chronic opioid use. Neuromodulation 23(1):126–132

  25. Kapural L, Nagem H, Tlucek H, Sessler DI (2010) Spinal cord stimulation for chronic visceral abdominal pain. Pain Med 11(3):347–355

    Article  PubMed  Google Scholar 

  26. Pollard EM, Lamer TJ, Moeschler SM, Gazelka HM, Hooten WM, Bendel MA, Warner NS, Murad H (2019) 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. J Pain Res 12:1311–1324

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Amirdelfan K, Vallejo R, Benyamin R et al (2019) High-frequency spinal cord stimulation at 10 kHz for the treatment of combined neck and arm pain. Results from prospective multicenter study. Neurosurgery nyz495. doi: https://doi.org/10.1093/neuros/nyz495

  28. El Majdoub F, Neudorfer C, Richter R, Schieferdecker S, Maarouf M (2019) 10 kHz cervical SCS for chronic neck and upper limb pain: 12 months’ results. Ann Clin Transl Neurol 6(11):2223–2229

  29. Burgher A, Kosek P, Surrett S et al (2020) 10 kHz SCS for treatment of chronic pain of the upper extremities: a post-market observational study. In Press

  30. Kapural L, Gupta M, Paicius R et al (2020) Treatment of chronic abdominal pain with 10 kHz spinal cord stimulation: safety and efficacy results from a 12-month prospective, multicenter, feasibility study clinical and translational. Gastroenterology 11:e00133

    Google Scholar 

  31. Sayed D, Kallewaard JW, Rotte A, Jameson J, Caraway D (2020) Pain relief and improvement in quality of life with 10 kHz SCS therapy: summary of clinical evidence. CNS Neurosci Ther 26:403–415

    Article  PubMed  PubMed Central  Google Scholar 

  32. Scherrer JF, Salas J, Copeland LA, Stock EM, Ahmedani BK, Sullivan MD, Burroughs T, Schneider FD, Bucholz KK, Lustman PJ (2016) Prescription opioid duration, dose, and increased risk of depression in 3 large patient populations. Ann Fam Med 14(1):54–62

    Article  PubMed  PubMed Central  Google Scholar 

  33. Scherrer JF, Salas J, Copeland LA, Stock EM, Schneider FD, Sullivan M, Bucholz KK, Burroughs T, Lustman PJ (2016) Increased risk of depression recurrence after initiation of prescription opioids in noncancer pain patients. J Pain 17(4):473–482

    Article  PubMed  PubMed Central  Google Scholar 

  34. Teh CF, Zaslavsky AM, Reynolds CF 3rd, Cleary PD (2010) Effect of depression treatment on chronic pain outcomes. Psychosom Med 72(1):61–67

    Article  PubMed  Google Scholar 

  35. Hatheway JA, Bansal M, Nichols-Ricker CI (2019) Systemic opioid reduction and discontinuation following implantation of intrathecal drug-delivery systems for chronic pain: a retrospective cohort analysis. Neuromodulation doi: https://doi.org/10.1111/ner.13053

  36. Salmon J (2019) High-frequency spinal cord stimulation at 10 kHz for widespread pain: a retrospective survey of outcomes from combined cervical and thoracic electrode placements. Postgrad Med 131(3):230–238

    Article  PubMed  Google Scholar 

  37. Al-Kaisy A, Van Buyten JP, Smet I, Palmisani S, Pang D, Smith T (2014) Sustained effectiveness of 10 kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study. Pain Med 15(3):347–354

    Article  PubMed  Google Scholar 

  38. DiBenedetto DJ, Wawrzyniak KM, Schatman ME, Kulich RJ, Finkelman M (2018) 10 kHz spinal cord stimulation: a retrospective analysis of real-world data from a community-based, interdisciplinary pain facility. J Pain Res 11:2929–2941

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Al-Kaisy A, Van Buyten JP, Carganillo R et al (2019) 10 kHz SCS therapy for chronic pain, effects on opioid usage: post hoc analysis of data from two prospective studies. Sci Rep 9(1):11441

    Article  PubMed  PubMed Central  Google Scholar 

  40. Van Buyten J-P, Al-Kaisy A, Smet I, Palmisani S, Smith T (2013) High-frequency spinal cord stimulation for the treatment of chronic back pain patients: results of a prospective multicenter European clinical study. Neuromodulation 16(1):59–66

    Article  PubMed  Google Scholar 

  41. Rapcan R, Mlaka J, Venglarcik M, Vinklerova V, Gajdos M, Illes R (2015) High-frequency – spinal cord stimulation. Bratisl Med J 116(06):354–356

    Article  CAS  Google Scholar 

  42. Kapural L, Yu C, Doust MW et al (2016) Comparison of 10-kHz high-frequency and traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: 24-month results from a multicenter, randomized, controlled pivotal trial. Neurosurgery 79(5):667–677

    Article  PubMed  PubMed Central  Google Scholar 

  43. Stauss T, El Majdoub F, Sayed D et al (2019) A multicenter real-world review of 10 kHz SCS outcomes for treatment of chronic trunk and/or limb pain. Ann Clin Transl Neurol 6(3):496–507

    Article  PubMed  PubMed Central  Google Scholar 

  44. Al-Kaisy A, Palmisani S, Smith TE et al (2018) Long-term improvements in chronic axial low back pain patients without previous spinal surgery: a cohort analysis of 10-kHz high-frequency spinal cord stimulation over 36 months. Pain Med 19(6):1219–1226

    Article  PubMed  Google Scholar 

  45. Al-Kaisy A, Palmisani S, Smith TE et al (2017) 10 kHz high-frequency spinal cord stimulation for chronic axial low back pain in patients with no history of spinal surgery: a preliminary, prospective, open label and proof-of-concept study. Neuromodulation 20(1):63–70

    Article  PubMed  Google Scholar 

  46. Al-Kaisy A, Van Buyten JP, Amirdelfan K et al (2019) Opioid sparing effects of 10 kHz spinal cord stimulation: a review of clinical evidence. Ann N Y Acad Sci 1462(1):53–64

  47. Van Buyten JP, Al-Kaisy A, Smet I, Palmisani S, Smith T (2013) High-frequency spinal cord stimulation for the treatment of chronic back pain patients: results of a prospective multicenter European clinical study. Neuromodulation 16(1):59–65 discussion 65-56

    Article  PubMed  Google Scholar 

  48. Sills S (2020) Treatment of painful polyneuropathies of diabetic and other origins with 10 kHz SCS: a case series. Postgrad Med:1–6

  49. Manchikanti L, Kaye AM, Knezevic NN, McAnally H, Slavin K, Trescot AM, Blank S, Pampati V, Abdi S, Grider JS, Kaye AD, Manchikanti KN, Cordner H, Gharibo CG, Harned ME, Albers SL, Atluri S, Aydin SM, Bakshi S, Barkin RL, Benyamin RM, Boswell MV, Buenaventura RM, Calodney AK, Cedeno DL, Datta S, Deer TR, Fellows B, Galan V, Grami V, Hansen H, Helm Ii S, Justiz R, Koyyalagunta D, Malla Y, Navani A, Nouri KH, Pasupuleti R, Sehgal N, Silverman SM, Simopoulos TT, Singh V, Solanki DR, Staats PS, Vallejo R, Wargo BW, Watanabe A, Hirsch JA (2017) Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician 20(2S):S3–S92

    Article  PubMed  Google Scholar 

  50. Matthias MS, Johnson NL, Shields CG, Bair MJ, MacKie P, Huffman M, Alexander SC (2017) “I’m not gonna pull the rug out from under you”: patient-provider communication about opioid tapering. J Pain 18(11):1365–1373

    Article  PubMed  PubMed Central  Google Scholar 

  51. Berna C, Kulich RJ, Rathmell JP (2015) Tapering long-term opioid therapy in chronic noncancer pain: evidence and recommendations for everyday practice. Mayo Clin Proc 90(6):828–842

    Article  PubMed  Google Scholar 

  52. Rosenberg JM, Bilka BM, Wilson SM, Spevak C (2018) Opioid therapy for chronic pain: overview of the 2017 US Department of Veterans Affairs and US Department of Defense clinical practice guideline. Pain Med 19(5):928–941

    Article  PubMed  Google Scholar 

  53. Pain Management Best Practices Inter-Agency Task Force Report (2019) In: Services USDoHaH, ed accessible online at (https://www.hhs.gov/ash/advisory-committees/pain/reports/index.html)

  54. The SUPPORT for Patients and Communities Act (H.R. 6) (2019) Accessible online at (https://www.asam.org/advocacy/the-support-for-patients-and-communities-act-(h.r.-6))

  55. IASP (2018) IASP Statement on Opioids February. 2018. Available at: https://www.iasp-pain.org/Advocacy/Content.aspx?ItemNumber=7194

  56. Dahlhamer J, Lucas J, Zelaya C et al (2018) Prevalence of chronic pain and high-impact chronic pain among adults - United States, 2016. MMWR Morb Mortal Wkly Rep 67(36):1001–1006

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Kansas Pain Management, 10995 Quivira, Overland Park, KS, 66201, USA

    Mayank Gupta

  2. University of Wisconsin, Madison, WI, USA

    Alaa Abd-Elsayed

  3. Advocate Illinois Masonic Medical Center, Chicago, IL, USA

    Nebojsa Nick Knezevic

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  1. Mayank Gupta
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  2. Alaa Abd-Elsayed
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  3. Nebojsa Nick Knezevic
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Correspondence to Mayank Gupta.

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Dr. Gupta is on scientific advisory board for Vertos Inc., consultant and speaker for Nevro Corp., Veritos Inc., and Foundation Fusion Solutions LLC and received research grants from BIOTRINK, Sollis Therapeutics Inc., Allergan, Axsome Therapeutics Inc., SPR Therapeutics Inc., Nalu Medical Inc., and Vertiflex Inc. Drs. Abd-Elsayed and Knezevic have no conflicts to disclose.

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Gupta, M., Abd-Elsayed, A. & Knezevic, N.N. Improving care of chronic pain patients with spinal cord stimulator therapy amidst the opioid epidemic. Neurol Sci 41, 2703–2710 (2020). https://doi.org/10.1007/s10072-020-04435-0

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