Journal of Pain Research (Nov 2018)
10 kHz spinal cord stimulation: a retrospective analysis of real-world data from a community-based, interdisciplinary pain facility
Abstract
David J DiBenedetto,1,2 Kelly M Wawrzyniak,1,2 Michael E Schatman,1,3 Ronald J Kulich,2,4 Matthew Finkelman5 1Boston PainCare, Waltham, MA, USA; 2Department of Diagnostic Sciences, Tufts School of Dental Medicine, Boston, MA, USA; 3Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA; 4Department of Anesthesia Critical Care and Pain Medicine, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA; 5Division of Biostatistics and Experimental Design, Tufts School of Dental Medicine, Boston, MA, USA Objective: To evaluate clinical outcomes and health care utilization at 12 months post spinal cord stimulator (SCS) implantation compared with baseline and a matched sample of patients receiving conventional medical management (CMM) for the treatment of low back and lower extremity pain.Patients: A retrospective study of patients with at least 24 months of active treatment at an interdisciplinary community pain center between December 1, 2014 and December 31, 2017. Thirty-two patients receiving implantation of a high-frequency (10 kHz) SCS and 64 patients receiving CMM were identified through propensity matching at a ratio of 2:1.Methods: Data were extracted from medical records, including pain severity, prescribed opioid dose in morphine milligram equivalents, patient perception of disability, and volume of interventional pain procedures and total office visits to the pain center.Results: Reductions in opioid dose were significantly greater for the SCS group than the CMM group. The 26.2 mg morphine equivalent dose reduction represents a 28% reduction from baseline, with 71.4% of those prescribed opioids in the SCS group reducing their dose at 12 months post-implant. Among those with SCS, there were significant within-group reductions in numerical pain score for low back and lower extremity pain, reducing by 46.2% and 50.9% from baseline, respectively. Change in functional pain score was not significant for either SCS group or CMM. Both groups had significant within-group reduction in disability. Reduction of interventional procedure volume was significant for both groups with a greater reduction observed in the SCS group. Office visit volume reduction was significant for the CMM group, but this was not a significant difference from the SCS group.Conclusions: Results support the efficacy of 10 kHz SCS for analgesia, reduction of opioid utilization, reduction of interventional pain procedures, and patient perception of disability. Keywords: high-frequency (10 kHz) spinal cord stimulation, analgesia, opioids, disability, economic variables
