Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 20;22(4):784-799.
doi: 10.1093/pm/pnab033.

Systemic Opioid Prescribing Patterns and Total Cost of Care in Patients Initiating Spinal Cord Stimulation Therapy: A Retrospective Analysis

Eduardo M Fraifeld  1 , John A Hatheway  2 , Christine N Ricker  3
Affiliations

Systemic Opioid Prescribing Patterns and Total Cost of Care in Patients Initiating Spinal Cord Stimulation Therapy: A Retrospective Analysis

Eduardo M Fraifeld et al. Pain Med. .

Abstract

Background: Few studies have evaluated patterns of systemic opioid use among patients initiating spinal cord stimulation therapy for chronic pain. This study evaluated systemic opioid discontinuation and/or dose reduction and total health care cost after the start of spinal cord stimulation therapy.

Methods: Using a commercial insurance claims database (2008-2017), we analyzed opioid utilization patterns in patients initiating spinal cord stimulation therapy over a 1-year baseline and 2-year follow-up. The primary end point was defined as either discontinuation (≥365-day gap between prescription fills or total days' supply in follow-up ≤30 days) or ≥50% reduction in average daily morphine milligram equivalent dose. "Costs" were defined as total payer plus patient out-of-pocket payments.

Results: A total of 5,878 patients met the selection criteria. Of these, 152 (2.6%) showed no opioid prescription data at any point in the study period. Among patients with one or more prescriptions, 42.0% met the primary end point (22.0% discontinued, and 20.0% reduced their dose by 50% or more). Mean total adjusted costs were significantly reduced in years 1 and 2 of follow-up relative to baseline (excluding device insertion costs). The average time to breakeven when accounting for device trial and permanent insertion cost was 3.1 years among those who met the composite end point and 4.2 years among those who did not.

Conclusions: This analysis shows that among patients who continued spinal cord stimulation therapy for at least 2 years, a significant proportion were able to reduce and/or discontinue systemic opioid use, with costs after the start of therapy significantly reduced relative to baseline.

Keywords: Discontinuation; Opioids; Spinal Cord Stimulation.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Patient selection. TDD = targeted drug delivery.
Figure 2.
Figure 2.
Opioid utilization over 2-year follow-up. An additional n=152 (2.6% of all study patients) showed no opioid utilization at any time from baseline through 2-year follow-up and were excluded from the proportions in the figure.
Figure 3.
Figure 3.
Mean and median MME (mg/day) by month from start of SCS.
Figure 4.
Figure 4.
Adjusted total payments by composite end point. Total payments exclude the cost of the SCS device and insertion procedure.
Figure 5.
Figure 5.
Adjusted total payments by follow-up opioid discontinuation and MME reduction status.
See this image and copyright information in PMC

Comment in

  • Does SCS Help Reduce Opioid Usage?
    North RB, Sharan AD. North RB, et al. Pain Med. 2021 Apr 20;22(4):772-773. doi: 10.1093/pm/pnab091. Pain Med. 2021. PMID: 33749797 No abstract available.

References

    1. CDC. Drug Overdose Deaths 2018. March 19, 2020. Available at: https://www.cdc.gov/drugoverdose/data/statedeaths.html (accessed January 4, 2021).
    1. Dowell D, Haegerich TM, Chou R.. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA 2016;315(15):1624–45. - PMC - PubMed
    1. Murphy L, Babaei-Rad R, Buna D, et al.Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions. Can Pharm J (Ott) 2018;151(2):114–20. - PMC - PubMed
    1. Rosenberg JM, Bilka BM, Wilson SM, Spevak C.. Opioid therapy for chronic pain: Overview of the 2017 US Department of Veterans Affairs and US Department of Defense clinical practice guideline. Pain Med 2018;19(5):928–41. - PubMed
    1. Yakovlev AE, Resch BE.. Spinal cord stimulation for cancer-related low back pain. Am J Hosp Palliat Care 2012;29(2):93–7. - PubMed

Substances