• Syed M Adil, Lefko T Charalambous, Charis A Spears, Musa Kiyani, Sarah E Hodges, Zidanyue Yang, Hui-Jie Lee, Shervin Rahimpour, Beth Parente, Kathryn A Greene, Mark McClellan, and Shivanand P Lad.
• Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.
• Neurosurgery. 2020 Dec 15; 88 (1): 193-201.

BackgroundOpioid misuse in the USA is an epidemic. Utilization of neuromodulation for refractory chronic pain may reduce opioid-related morbidity and mortality, and associated economic costs.ObjectiveTo assess the impact of spinal cord stimulation (SCS) on opioid dose reduction.MethodsThe IBM MarketScan® database was retrospectively queried for all US patients with a chronic pain diagnosis undergoing SCS between 2010 and 2015. Opioid usage before and after the procedure was quantified as morphine milligram equivalents (MME).ResultsA total of 8497 adult patients undergoing SCS were included. Within 1 yr of the procedure, 60.4% had some reduction in their opioid use, 34.2% moved to a clinically important lower dosage group, and 17.0% weaned off opioids entirely. The proportion of patients who completely weaned off opioids increased with decreasing preprocedure dose, ranging from 5.1% in the >90 MME group to 34.2% in the ≤20 MME group. The following variables were associated with reduced odds of weaning off opioids post procedure: long-term opioid use (odds ratio [OR]: 0.26; 95% CI: 0.21-0.30; P < .001), use of other pain medications (OR: 0.75; 95% CI: 0.65-0.87; P < .001), and obesity (OR: 0.75; 95% CI: 0.60-0.94; P = .01).ConclusionPatients undergoing SCS were able to reduce opioid usage. Given the potential to reduce the risks of long-term opioid therapy, this study lays the groundwork for efforts that may ultimately push stakeholders to reduce payment and policy barriers to SCS as part of an evidence-based, patient-centered approach to nonopioid solutions for chronic pain.Copyright © 2020 by the Congress of Neurological Surgeons.

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