In patients undergoing spinal cord stimulation for lower extremity pain, the use of neuropathic pain medication and opioids prior to the procedure may not have an impact on outcomes, according to research published in Neuromodulation.
In this retrospective study, the pharmacological profiles of 115 participants undergoing spinal cord stimulation therapy for lower extremity pain were assessed. The researchers evaluated the associations between pharmacological profile and a successful spinal cord stimulation trial (50% decrease in pain during trial), a 50% decrease in pain after 1 year, and a 50% decrease in opioid use after 1 year.
Use of opioids and neuropathic pain medications before treatment was not associated with the likelihood of a successful spinal cord stimulation trial or with a 50% decrease in pain after 1 year.
However, an increased opioid dose prior to the intervention was associated with an increased rate of a 50% reduction in opioid use after 1 year (odds ratio, 1.02; P <.01). According to the researchers, higher opioid doses may be associated with decreased opioid use following surgery because of the ability of the procedure to decrease opioid reliance without increasing pain.
The study investigators explained that that their results suggest that “[spinal cord stimulation] therapy could be a tool to help reduce opioid use.” Although they noted that the mechanism remains unclear, concluding: “Controlled trials would be valuable in continued development of our understanding of [spinal cord stimulation] mechanisms and optimal medication management.”
Maher DP, Martins YC, Doshi T, et al. Neuropathic pain medication use does not alter outcomes of spinal cord stimulation for lower extremity pain [published online October 4, 2017]. Neuromodulation. doi: 10.1111/ner.12697