Pain Relief and Opioid Usage in Upper Limb and Neck Pain Patients After 10-kHz Spinal Cord Stimulation Treatment: Subanalysis of USA Studies

Abstract

Aim: It is argued that chronic pain patients who reduce/eliminate their opioids may have compromised pain relief. This study therefore aimed to analyze if reduced opioid consumption associated with 10-kHz spinal cord stimulation adversely affected pain relief. Methods:Post hoc analysis was performed on data from two prospective studies in subjects with upper limbs and neck pain conducted in USA. Results & conclusion: A 10-kHz spinal cord stimulation treatment was associated with reduction in mean visual analog scale scores for upper limbs and neck pain and mean daily opioid consumption. Pain scores decreased in subjects who decreased opioid use and in those who maintained/increased use. Opioid reduction and pain relief was also achieved in subjects taking >90 mg morphine equivalents of opioids at baseline.

Lay abstract

Weaning off opioids or reducing the dose in patients with chronic pain is believed to increase the pain intensity. The guidance issued by Health and Human Services in 2019 highlighted the need to balance risks and benefits during tapering, and the importance of incorporating opioid-sparing treatments for chronic pain. 10-kHz spinal cord stimulation (SCS) has been previously shown to provide durable pain relief and help in reducing dependence on opioids for pain management. Current study further showed that 10-kHz SCS treatment helped patients with chronic upper limb and neck pain in reducing opioid dependence. More importantly, current study demonstrated that there was no rebound increase in 10-kHz SCS treated patients who reduced/eliminated opioid use.

Keywords::

• 10 kHz SCS
• chronic pain
• opioids
• VAS

Author contributions

Authors K Amirdelfan, R Vallejo, R Benyamin, S Rosen, P Kosek and A Burgher were involved in data collection, analysis and writing of the manuscript. D Caraway was involved in design, conceptualization and writing of the manuscript. AR was responsible for analysis, design, conceptualization and working with medical writer in drafting the manuscript. All the authors have reviewed and approved the final version of this manuscript.

Acknowledgments

Authors thank E MacLaren, Galen Medical Writing LLC, for drafting the manuscript and M Bhandaru, for preparing the illustrations for the manuscript.

Financial & competing interests disclosure

This study was funded by Nevro Corp. K Amirdelfan, R Benyamin and S Rosen are consultants of Nevro Corp. D Caraway and A Rotte are employees of Nevro Corp. R Vallejo is an employee of Stimgenics and a consultant for Medtronic and Avanos. P Kosek received research grants from Boston Scientific and Nevro Corp. A Burgher has no conflicts to disclose. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

E MacLaren, Galen Medical Writing LLC, drafted the manuscript, M Bhandaru, prepared the illustrations and Nevro Corp. funded the production of this manuscript.

Ethical conduct of research

Study was performed in compliance with US Code of Federal Regulations and recommendations guiding physicians in biomedical research adopted by the 18th World Medical Assembly, Helsinki, Finland. Informed consent forms and study protocols were reviewed and approved by Institutional Review Board prior to the beginning of the study. All patients provided informed consent for data collection including medication for management of pain and for reporting of data.

Additional information

Funding

This study was funded by Nevro Corp. K Amirdelfan, R Benyamin and S Rosen are consultants of Nevro Corp. D Caraway and A Rotte are employees of Nevro Corp. R Vallejo is an employee of Stimgenics and a consultant for Medtronic and Avanos. P Kosek received research grants from Boston Scientific and Nevro Corp. A Burgher has no conflicts to disclose. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. E MacLaren, Galen Medical Writing LLC, drafted the manuscript, M Bhandaru, prepared the illustrations and Nevro Corp. funded the production of this manuscript.