Improving care of chronic pain patients with spinal cord stimulator therapy amidst the opioid epidemic
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REVIEW ARTICLE
Improving care of chronic pain patients with spinal cord stimulator therapy amidst the opioid epidemic Mayank Gupta 1 & Alaa Abd-Elsayed 2 & Nebojsa Nick Knezevic 3 Received: 13 February 2020 / Accepted: 16 April 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract The US government and other key stakeholders including professional medical bodies have amended recommendations in recent years to emphasize using no opioids or the lowest effective dose of opioids needed for treatment of chronic pain. However, there remains an unmet need for pain treatments that can both relieve the pain of patients and reduce the doses of opioids they require. The Center for Medicare and Medicaid Services (CMS) is currently considering such treatments through the SUPPORT ACT and has recently conferred with the Health and Human Services (HHS) Inter-agency Pain Management Task Force to consider such therapies. We reviewed literature evidence in PubMed on pain relief and opioid reduction following spinal cord stimulation (SCS) treatment. SCS presents an effective non-pharmacologic pain treatment modality that has been used for decades to reduce chronic pain from trauma or neuropathy and has been shown to either stabilize or reduce opioid use in some patients with painful conditions. A more recently developed high-frequency SCS modality, 10 kHz SCS, has the advantage of being paresthesiaindependent. It has been shown to be associated with significant reductions in opioid consumption after stimulation therapy was initiated, and many patients even taking high doses of opioids (> 90 mg morphine equivalent dose per day) were able to reduce their opioid intake to levels associated with less risk. The evidence shows that reduction of opioids as early in the treatment process as possible is desirable to reduce patient risk and improve pain relief from stimulation therapy. Keywords Chronic pain . 10 kHz SCS . Opioids
Introduction The USA is in the midst of an opioid crisis that resulted in 47,600 deaths due to opioid overdose in 2017, including 17,029 overdoses involving prescription opioids [1]. Indeed, fatal opioid overdoses have become so common that the lifetime risk of mortality associated with these drugs has exceeded that of car accidents in the USA for the first time on record [2]. This epidemic of opioid-related deaths has resulted in a rising awareness of the need for innovative treatment modalities that can provide better effectiveness over the
* Mayank Gupta [email protected] 1
Kansas Pain Management, 10995 Quivira, Overland Park, KS 66201, USA
2
University of Wisconsin, Madison, WI, USA
3
Advocate Illinois Masonic Medical Center, Chicago, IL, USA
use of long-term opioid therapy in patients with chronic, refractory pain. High-dose opioid therapy poses risks to patients with chronic pain, with common adverse events including hyperalgesia, psychological dependence, tolerance, risk of overdose, and death due to respiratory depression [3–5]. In contrast to the large body of evidence of their risk
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