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. 2023 Jan 1;80(1):18-29.
doi: 10.1001/jamaneurol.2022.4166.

Long-term Outcomes in Use of Opioids, Nonpharmacologic Pain Interventions, and Total Costs of Spinal Cord Stimulators Compared With Conventional Medical Therapy for Chronic Pain

Sanket S Dhruva  1   2   3 , Jaime Murillo  4 , Omid Ameli  5 , Pamela E Morin  4 , Donna L Spencer  4 , Rita F Redberg  2   6 , Ken Cohen  5
Affiliations

Long-term Outcomes in Use of Opioids, Nonpharmacologic Pain Interventions, and Total Costs of Spinal Cord Stimulators Compared With Conventional Medical Therapy for Chronic Pain

Sanket S Dhruva et al. JAMA Neurol. .

Abstract

Importance: Spinal cord stimulators (SCSs) are increasingly used for the treatment of chronic pain. There is a need for studies with long-term follow-up.

Objective: To determine the comparative effectiveness and costs of SCSs compared with conventional medical management (CMM) in a large cohort of patients with chronic pain.

Design, setting, and participants: This was a 1:5 propensity-matched retrospective comparative effectiveness research analysis of insured individuals from April 1, 2016, to August 31, 2018. This study used administrative claims data, including longitudinal medical and pharmacy claims, from US commercial and Medicare Advantage enrollees 18 years or older in Optum Labs Data Warehouse. Patients with incident diagnosis codes for failed back surgery syndrome, complex regional pain syndrome, chronic pain syndrome, and other chronic postsurgical back and extremity pain were included in this study. Data were analyzed from February 1, 2021, to August 31, 2022.

Exposures: SCSs or CMM.

Main outcomes and measures: Surrogate measures for primary chronic pain treatment modalities, including pharmacologic and nonpharmacologic pain interventions (epidural and facet corticosteroid injections, radiofrequency ablation, and spine surgery), as well as total costs.

Results: In the propensity-matched population of 7560 patients, mean (SD) age was 63.5 (12.5) years, 3080 (40.7%) were male, and 4480 (59.3%) were female. Among matched patients, during the first 12 months, patients treated with SCSs had higher odds of chronic opioid use (adjusted odds ratio [aOR], 1.14; 95% CI, 1.01-1.29) compared with patients treated with CMM but lower odds of epidural and facet corticosteroid injections (aOR, 0.44; 95% CI, 0.39-0.51), radiofrequency ablation (aOR, 0.57; 95% CI, 0.44-0.72), and spine surgery (aOR, 0.72; 95% CI, 0.61-0.85). During months 13 to 24, there was no significant difference in chronic opioid use (aOR, 1.06; 95% CI, 0.94-1.20), epidural and facet corticosteroid injections (aOR, 1.00; 95% CI, 0.87-1.14), radiofrequency ablation (aOR, 0.84; 95% CI, 0.66-1.09), or spine surgery (aOR, 0.91; 95% CI, 0.75-1.09) with SCS use compared with CMM. Overall, 226 of 1260 patients (17.9%) treated with SCS experienced SCS-related complications within 2 years, and 279 of 1260 patients (22.1%) had device revisions and/or removals, which were not always for complications. Total costs of care in the first year were $39 000 higher with SCS than CMM and similar between SCS and CMM in the second year.

Conclusions and relevance: In this large, real-world, comparative effectiveness research study comparing SCS and CMM for chronic pain, SCS placement was not associated with a reduction in opioid use or nonpharmacologic pain interventions at 2 years. SCS was associated with higher costs, and SCS-related complications were common.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Dhruva reported receiving grants from Arnold Ventures; research funding from the Greenwall Foundation, the Department of Veterans Affairs, the National Evaluation System for Health Technology Coordinating Center, the US Food and Drug Administration, and the National Institute for Health Care Management; and serving on the Institute for Clinical and Economic Review California Technology Assessment Forum. Dr Murillo reported being an employee and stockholder of UnitedHealth Group and being a full-time employee of Optum Labs UnitedHealth Group outside the submitted work. Dr Ameli reported being a full-time employee of Optum Center for Research and Innovation and Optum Labs during the conduct of the study. Ms Morin reported being a full-time employee of Optum Labs during the conduct of the study and purchasing UnitedHealth Group stock as an employee. Dr Spencer was a full-time employee of Optum Labs during the conduct of the study and reported purchasing stock in UnitedHealth Group as an employee. Dr Redberg reported receiving grants from Arnold Ventures and Greenwall Foundation outside the submitted work; and serving on the Institute for Clinical and Economic Review California Technology Assessment Forum. Dr Cohen reported being an employee of Optum Center for Research and Innovation and Optum Labs. No other disclosures were reported.

Figures

Figure.
Figure.. Costs of Care Among Propensity-Matched Patients Treated With Spinal Cord Stimulators (SCSs) vs Conventional Medical Management (CMM)
A, Mean annual total all-cause cost of care. B, Mean annual medical and outpatient pharmacy cost of care.
See this image and copyright information in PMC

Comment in

References

    1. Gharibo C, Laux G, Forzani BR, Sellars C, Kim E, Zou S. State of the field survey: spinal cord stimulator use by academic pain medicine practices. Pain Med. 2014;15(2):188-195. doi:10.1111/pme.12264 - DOI - PubMed
    1. Leung N, Tsourmas NF, Yuspeh L, et al. . Increased spinal cord stimulator use and continued opioid treatment among injured workers: a regional pilot study. J Occup Environ Med. 2020;62(8):e436-e441. doi:10.1097/JOM.0000000000001933 - DOI - PubMed
    1. US Food and Drug Administration . Conduct a trial stimulation period before implanting a spinal cord stimulator (SCS)—letter to health care providers. Accessed May 20, 2022. https://www.fda.gov/medical-devices/letters-health-care-providers/conduc...
    1. Global Market Insights Inc . Neurostimulation devices market value to hit $19 billion by 2025: Global Market Insights, Inc. Accessed May 20, 2022. https://www.prnewswire.com/news-releases/neurostimulation-devices-market...
    1. Poree L, Krames E, Pope J, Deer TR, Levy R, Schultz L. Spinal cord stimulation as treatment for complex regional pain syndrome should be considered earlier than last resort therapy. Neuromodulation. 2013;16(2):125-141. doi:10.1111/ner.12035 - DOI - PubMed

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