Journal of Pain Research (May 2024)
Long-Term Reductions in Opioid Medication Use After Spinal Stimulation: A Claims Analysis Among Commercially-Insured Population
Abstract
Robert Jason Yong,1 Oth V Tran,2 Alysha M McGovern,2 Parag G Patil,3 Christopher J Gilligan1 1Pain Management Center, Brigham and Women’s Hospital, Chestnut Hill, MA, USA; 2Health Economics and Outcomes Research, Boston Scientific Corporation, Marlborough, MA, USA; 3Neurological Surgery, University of Michigan, Ann Arbor, MI, USACorrespondence: Alysha M McGovern, Health Economics and Outcomes Research, Boston Scientific Corporation, 300 Boston Scientific Way, Marlborough, MA, 01752, USA, Tel +1 774-249-5560, Email [email protected]: Chronic, non-cancer pain significantly and negatively impacts patient quality of life. Neuromodulation is a major component of multi-modal interdisciplinary approaches to chronic pain management, which includes opioid and nonopioid medications. In randomized controlled trials, spinal cord stimulation (SCS) has been shown to reduce pain and decrease short-term opioid use for patients. This study sought to evaluate the effect of SCS on longer term opioid and non-opioid pain medication usage among patients over ≥ 3 years of follow-up.Patients and Methods: Claims analysis was conducted using the Merative™ MarketScan® Commercial Database. Patients aged ≥ 18 who initiated SCS between 1/1/2010 and 3/31/2021 with ≥ 1 year of baseline data and ≥ 3 years of follow-up data were included. Opioid discontinuation, daily dose (DD) reduction, proportion of days covered (PDC), concomitant co-medication with benzodiazepines and/or gabapentinoids, and polypharmacy were evaluated during the baseline and follow-up periods. Adjusted logistic regression was used to evaluate the impact of baseline dosages on discontinuation and dose reduction.Results: During follow-up, 60% of 2,669 SCS patients either discontinued opioid use or reduced opioid DD by at least 20% from baseline; another 15% reduced DD by 1– 19%. Logistic regression showed patients with higher baseline dosages were less likely to discontinue opioids completely (odds ratio[OR] 95% confidence intervals[CI]: 0.31[0.18,0.54]) but more likely to reduce their daily dose (OR[CI]: 7.14[4.00,12.73], p< 0.001). Mean PDC with opioids decreased from 0.58 (210 of 365 days) at baseline to 0.51 at year 3 (p< 0.001). With SCS, co-medication with benzodiazepines decreased from 47.3% at baseline to 30.3% at year 3, co-medication with gabapentinoids reduced from 58.6% to 42.2%, and polypharmacy dropped from 15.6% to 9.6% (all p< 0.001).Conclusion: Approximately three-quarters of patients who received SCS therapy either discontinued or reduced systemic opioid use over the study period. SCS could assist in reducing long-term reliance on opioids and other pain medications to treat chronic non-cancer pain.Keywords: chronic pain, opioid misuse, spinal cord stimulation, opioid medication
