New research from Thomas Jefferson University in Philadelphia is giving new hope to those suffering with chronic pain. The research, sponsored by Abbott Laboratories, involved the examination of opioid usage in more than 5,400 patients both prior to and after receiving a spinal cord stimulation (SCS) system implant. According to the January 20, 2017 news release, the researchers found that “opioid use declined or stabilized in 70% of patients who received an SCS system.”
Spinal Cord Stimulation Reduces Opioid Use
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“As our society has been seeking ways to stem opioid abuse and [in] addition, our company offers treatment options that can reduce their exposure to opioid medication,” said Allen Burton, M.D., medical director of neuromodulation at Abbott. “Data like these are critical to helping us demonstrate that spinal cord stimulation can reduce exposure to opioids while giving patients comprehensive pain relief.”
" data-large-file="https://i0.wp.com/ryortho.com/wp-content/uploads/2017/02/Spinal_MedianMEDQuarter_WEB.jpg?fit=730%2C364&ssl=1" src="https://i0.wp.com/ryortho.com/wp-content/uploads/2017/02/Spinal_MedianMEDQuarter_WEB.jpg?resize=730%2C364&ssl=1" alt="" width="730" height="364">Morphine equivalent dose (MED) in patients with effective SCS (blue) and those who had their SCS explanted (gray) before and after SCS implant (dashed line). Left: solid lines are median and shaded areas are interquartile ranges. Right: solid lines are mean and shaded areas are SE./Courtesy of Congress of Neurological Surgeons
Ashwini Sharan, M.D. is director of Functional and Epilepsy Surgery at Vickie and Jack Farber Institute for Neuroscience at Jefferson. He told OTW, “I have always felt that spinal cord stimulation works very effectively in managing patients’ pain but did not know if the therapy helped reduce medication use, as well. We had to complete a population-based study using thousands of patients to find out what is happening with their medication management. We wanted to see if there was a secondary benefit and how it can be measured objectively.”
Asked why this hasn’t been demonstrated previously, Dr. Sharan noted, “The problem is in the process; unless doctors go out and collect data then there will be no compiled evidence. The doctor has to have a passionate about it in order to make the study happen. Also, companies don’t do post-marketing studies. It’s just not the culture. It comes down to time and resources.”
“If they see that patients are taking more and more pain killers then they have to identify that something is wrong. There should be a correlation between the patients’ pain and anxiety levels. An increase in the use of narcotics often just means that patients are developing a tolerance. Narcotic use is almost never a solution to chronic pain.”
“The study needs to be replicated. We need to be able to provide tools to physicians to help identify when patients are developing this narcotic tolerance and identify earlier when patients are candidates for these types of therapies. Right now these tools don’t exist.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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