Health-Care Utilization and Outcomes with 10 kHz Spinal Cord Stimulation for Chronic Refractory Pain

Abstract

Background: Chronic pain is a common condition associated with decreased quality of life and increased health-care costs. Opioid analgesics are routinely used to treat chronic pain despite limited evidence of long-term efficacy. Spinal cord stimulation at a frequency of 10 kilohertz (10kHz-SCS) has been shown to be effective for treating chronic pain.

Objective: This study was conducted to evaluate the effects of 10kHz-SCS on patients' pain intensity, volume of pain interventions, and opioid intake in a real-world setting.

Study design: This study was a retrospective review of patient data.

Setting: The study was conducted at a single, community-based clinic.

Methods: Outcomes including pain relief, quality of life, opioid intake, and rate of health-care usage were evaluated using data from patients who were implanted with a 10kHz-SCS device to treat chronic pain. These outcomes were then compared for the pre- and post-implant periods.

Results: A total of 47 patients with a mean follow-up duration of 15.6 ± 6.2 months were included in this analysis. Mean pain relief was 73 ± 22% and 89% were responders at the final follow-up visit. The rate of medical interventions fell from 3.48±3.05 per year before starting 10kHz-SCS to 0.49±1.16 per year afterward (P < 0.001). Of 30 patients with available opioid consumption data, 89% maintained or decreased their intake after implant.

Conclusion: Retrospective data from a single center, with minimal exclusion criteria shows clinically significant pain relief with 10kHz-SCS, accompanied by significant indirect benefits including stable or reduced opioid use and reduced interventional procedures.

Keywords: chronic pain; health care costs; opioid analgesics; pain management; spinal cord stimulation.

Figure 1

The selection of patient records for use in the retrospective analysis and prospective follow-up are shown in this flow chart.

Figure 2

The pain relief associated with 10 kHz SCS was calculated from patient-reported pain scores collected before implant and at the last follow-up. (A) The tornado plot shows the individual scores for each patient, relative to the 50% threshold that defined responders and non-responders. (B) Mean (± SD) pre- and post- implant scores in multiple pain domains. As indicated by the (*), all domains were significantly different pre and post implant using the One-Way ANOVA test to compare means.

Figure 3

Patients’ mean rate of medical interventions per year (± SD) is shown before and after implant of the 10 kHz SCS device, with (*) indicating statistically different (One-way ANOVA, p < 0.001).

Figure 4

The changes in patient opioid consumption after implant is shown in (A). (B) Shows, the pre- and post-implant distributions of opioid consumption in the patient sample.

Figure 5

Patient-reported scores for quality of life and satisfaction. (A) Quality of life as assessed at the last follow-up using the “Quality of Life Score” (American Chronic Pain Institute). Ranges from 0:”stay in bed all day. Feel hopeless and helpless about life”, to 10: “Go to work/volunteer each day. Normal daily activities each day. Have a social life outside of work. Take an active part in family life.” (B) Reported satisfaction with the therapy (scale of 1 to 10), 1 = Not Satisfied at all, to 10 = Extremely Satisfied.