• Pain physician · Aug 2022

    Disability Pension Did Not Reduce Opioid Use Among Patients With Failed Back Surgery Syndrome Who Were Trialed and Implanted for Spinal Cord Stimulation.

    • Hanna Kaijankoski, Mette Nissen, Janne Pesonen, Tiina-Mari Ikaheimo, Mikael von Und Zu Fraunberg, Olavi Airaksinen, and Jukka Huttunen.
    • Department of Rehabilitation, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
    • Pain Physician. 2022 Aug 1; 25 (5): E739-E748.

    BackgroundSpinal cord stimulation (SCS) is an effective treatment for failed back surgery syndrome (FBSS). In patients with FBSS, opioids have often been initiated, even before SCS is trialed.ObjectiveWe studied the effect of retirement on opioid use in patients with chronic pain after failed back surgery.Study DesignA retrospective study design.SettingThe study was conducted at Kuopio University Hospital.MethodsThe study group consisted of all 230 patients with SCS trialed or implanted for FBSS at Kuopio University Hospital Neurosurgery from January 1, 1996 through December 31, 2014. All purchases of prescribed opioids and their daily defined doses, as well as data on working ability, were obtained from the Social Insurance Institution. Patients were divided into 3 groups: SCS trial only, SCS implanted permanently, and SCS implanted but later explanted. We analyzed the differences in opioid use among these groups 2 years before and 2 years after the start of their disability pension (DP).ResultsDuring the follow-up period, a total of 60 patients received a DP. One year before DP, the majority of patients used opioids (n = 43, 72%), and throughout the one-year follow-up after retirement, the number of users increased slightly (n = 46, 77%). In the permanently implanted SCS group, the number of strong opioid users decreased after retirement. Most patients used a moderate dose (0.1-10.5 morphine milligram equivalent/d). Retirement appeared to interrupt dose escalation in all groups, but doses increased further as the follow-up continued.LimitationsNo structured questionnaires were used in this study. Also, many underlying factors contributing to chronic pain were missing.ConclusionsDP did not reduce the use of opioids in patients with FBSS. Opioid doses were lower and dose escalation less steep with continuous SCS therapy.

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