Spinal cord stimulation (SCS) for postlaminectomy syndrome (PLS) is associated with small, clinically questionable opioid discontinuation and a lower rate of new opioid use in patients who were previously opioid-naïve. These were the findings of new research, published by Steven P Cohen (Johns Hopkins School of Medicine, Baltimore, USA) et al in JAMA Network Open.
The aim of this cohort study was to determine the association between SCS and long-term opioid therapy (LOT) for PLS. Speaking to Spinal News International, Cohen said: “SCS is often used and justified on the basis of opioid-sparing properties, but in a real-world population, the effect is very small and clinically questionable. This suggests a need to better identify likely responders.”
Adults with PLS were identified using the TriNetx Diamond Network and separated based on whether or not they underwent SCS. Patients were stratified according to baseline opioid use (opioid-naïve or receiving LOT) and subsequent opioid therapy over the 12-month period ranging from three to 15 months post-SCS implantation or post-PLS index date.
The main outcome was cessation of opioid use among patients receiving LOT or abstinence from opioids among opioid-naïve patients. Opioid-naïve patients were defined as those receiving at most two opioid prescriptions per year, and patients on LOT were those receiving at least six opioid prescriptions per year.
Of 552,937 eligible patients who were treated between December 2015 and May 2021, a total of 26,179 with PLS received an SCS implant.
The median patient age was 60 (51-69) years and 305,802 patients (55.3%) were female. Of those who reported race (204,758 patients [37%]), 18.971 (9.3%) were African American, 648 (0.3%) were Asian and 185,139 (90.4%) were White.
The study found that those who received an SCS were more likely to be using opioids preimplantation than those who did not (mean prescriptions: 4.3 [standard deviation 8.5] vs. 4.1 [SD 9.3]; p<0.001) but less likely to be using opioids after SCS implantation (mean prescriptions: 3.8 [8.2] vs. 4 [9.4]; p=0.006).
In the 12-month study period, similar proportions in the SCS and no-SCS groups receiving baseline LOT remained on LOT (70.3% vs. 69.2%, respectively; p=0.10). In opioid-naïve patients, SCS was associated with a small decreased likelihood of patients subsequently receiving LOT (7.6% vs. 7%; difference, −0.6% [95% confidence interval (CI), −1% to −0.2%]; p=0.003).
In multivariable analysis, SCS was associated with an increased likelihood of not being on opioids in both opioid-naïve (adjusted odds ratio [OR], 0.9 [95% CI, 0.85-0.96]; p<0.001) and LOT patients (adjusted OR, 0.93 [95% CI, 0.88-0.99]; p=0.02).
White patients were significantly more likely to be diagnosed with PLS (90.4% vs. 85.2%; difference, 5.2% [95% CI, 5.1%-5.4%]; p<0.001) and receive an SCS (93.7% vs. 90.3%; difference, 3.4% [95% CI, 2.9% to 4%]; p<0.001) than patients of other racial identities.