Perceptions of Pain in Aging Females Undergoing Spinal Cord Stimulation

Abstract

Aim: Effects of age and sex on chronic pain outcomes following spinal cord stimulation (SCS) have not yet been assessed. Methods: We retrospectively reviewed 1 year outcomes from a database of patients receiving thoracic SCS. Subjects were divided into four cohorts: pre-menopausal and post-menopausal females, and aged-matched males. Improvement using the numerical rating scale, Oswestry Disability Index (ODI), Beck’s Depression Inventory (BDI), McGill Pain Questionnaire and Pain Catastrophizing Scale (PCS) was assessed. Results: Older females were notably different from males and females under 60 as they had greater improvements in ODI, BDI and PCS. Further, females ≥60 had greater improvement in PCS compared with males ≥60. Conclusion: Our findings suggest greater improvement with 1 year SCS treatment in post-menopausal females, compared with age-matched males.

Plain language summary

Spinal cord stimulation (SCS) has been shown to be an effective treatment for chronic pain that does not respond to other therapies. It is well recognized that men and women differ in how they perceive pain and how they respond to pain treatments. However, whether women who are over 60 years old and thus presumed to be menopausal respond differently to SCS has not been evaluated. We looked at our database which collected outcomes related to pain, measured before patients had SCS and 1 year after SCS. We found that women over 60 responded better to SCS treatment. They experienced significantly greater improvements in the disability, depression and catastrophizing associated with their pain than did women under 60. Further SCS resulted in more improvements in catastrophizing in women over 60 than in men over 60. Taken together, our hope is that these data help physicians to determine the best patients for SCS and to counsel their patients appropriately. To the best of our knowledge, this study is the first to show the impact of sex-specific aging on response to spinal cord stimulation. While we used age as a surrogate for menopause, menopausal status should be documented in the future to confirm that it effects response.

Keywords::

• aging
• chronic pain
• menopause
• perception
• spinal cord stimulation

Author contributions

The authors confirm contribution to the paper as follows: UE Hani Abdullah: formal analysis, writing – original draft. S Kelly: writing – original draft & editing. A Ricker: formal analysis. M Nabage: writing – original draft. O Khazen: writing – original draft. I Telkes: formal analysis. M DiMarzio: writing – original draft. C Wilson: writing – original draft. JG Pilitsis: supervision, writing – review & editing, resources, project administration.

Acknowledgments

All authors reviewed the results and approved the final version of the manuscript.

Financial disclosure

JG Pilitsis receives grant support from Medtronic, Boston Scientific, Abbott, NIH 2R01CA166379-06 and NIH U44NS115111. I Telkes receives grant support from NIH R00NS119672 and NIH U44NS115111. 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.

Competing interests disclosure

JG Pilitsis is the medical advisor for Aim Medical Robotics and has stock equity. The authors have no other competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Additional information

Funding

JG Pilitsis receives grant support from Medtronic, Boston Scientific, Abbott, NIH 2R01CA166379-06 and NIH U44NS115111. I Telkes receives grant support from NIH R00NS119672 and NIH U44NS115111. 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.