High Frequency Spinal Cord Stimulation Reduces Daily Opioid Dose in Chronic Pain

High-frequency spinal cord stimulation resulted in pain relief and halved the mean daily dose of conventional opioid use in patients with chronic pain, according to a review published in the Annals of the New York Academy of Sciences.

The investigators of this study sought to review the efficacy of 10 kHz spinal cord stimulation for reducing pain and for potentiating the reduction or elimination of opioid use in patients with chronic, noncancer pain. They examined multiple prospective and retrospective studies on patients undergoing 10 kHz spinal cord stimulation for intractable pain, including lower back and neuropathic pain; many patients had been reported as being unresponsive to conventional pain interventions. The investigators defined treatment response as ≥50% pain relief (with no neurological deficit) in >70% of participants after 1 year of treatment.

In the studies identified for review (1 randomized controlled trial, 3 prospective open-label studies, and 3 real-world studies), pain relief from 10 kHz spinal cord stimulation ranged from 54% to 87%. 

In the randomized controlled trial, the average daily dose of opioid analgesics fell by 18.8% with 10 kHz spinal cord stimulation vs a 1% decrease with traditional, low-frequency spinal cord stimulation (P =.014).

In nonrandomized, prospective studies, 62% of participants reduced opioid use whereas 38% eliminated the use of opioid medications completely; reductions in pain and opioid use continued for 24 months.

In real-world studies, pain scores on average were cut in half and responder rates were reported in three-quarters of the participants; at least 32.1% decreased or eliminated conventional opioid use during follow-up.

The safety profile of 10 kHz spinal cord stimulation was similar to that of traditional spinal cord stimulation; no studies reported neurological deficits and explant occurred in less than 3.7% of all patients.

The investigators of the study concluded that 10 kHz spinal cord stimulation is a potential treatment for different types of chronic pain, especially in patients who are unresponsive to conventional treatments. They further concluded that pain treatments with 10 kHz spinal cord stimulation in conjunction with a targeted strategy to reduce opioid use may achieve even greater rates of abstinence.

Disclosure: Several study authors declared affiliations with Nevro Corporation. Please see the original reference for a full list of authors’ disclosures.

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Reference          

Al-Kaisy A, Van Buyten JP, Amirdelfan K, et al. Opioid-sparing effects of 10 kHz spinal cord stimulation: a review of clinical evidence [published online October 2, 2019]. Ann N Y Acad Sci. doi:10.1111/nyas.14236