Spinal Cord Stimulation Therapy, Opioid Prescribing Patterns

Researchers recently presented at the American Academy of Pain Medicine’s 36th Annual Meeting on the association of systemic opioid prescribing patterns and total cost of care for patients beginning spinal cord stimulation (SCS) therapy. 

SCS is typically used as a treatment for chronic pain. A spinal cord stimulator is a type of implantable neuromodulation device that is used to send electronic signals to select areas of the spinal cord for the treatment of various pain conditions.

Eduardo Frailfeld, MD, DABPM, DABA, Spectrum Medical, Danville, VA, and colleagues used a commercial insurance database with data from 2018 to 2017 and selected patients who initiated SCS therapy and followed for 1-year baseline and 2-year follow up. All systemic opioid prescriptions were converted into morphine milligram equivalents (MME). 

“The primary endpoint was defined as: discontinuation (≥365-day gap between prescription fills or total days’ supply in follow-up ≤30 days) OR ≥50% reduction in average daily MME,” explained Dr Frailfeld and colleagues. 

The measured costs were calculated by total payer plus patient payments, adjusted in multivariate difference-in-difference regressions.

The final cohort included 5902 patients, with 153 (2.6%) who had no prior opioid prescriptions during the study period. 

Per the results, for patients with ≥1 prescription, 42.4% met the primary endpoint , with 21.8% discontinuing and 20.5% with ≥50% dose reduction.

The researchers noted that indication for SCS was not correlated with probability of meeting the primary endpoint, while age, anticonvulsant or NSAID use, and baseline avg daily MME were. 

The mean total costs associated with SCS and opioid prescribing patterns were significantly reduced in years 1 and 2 of follow-up relative to baseline (excluding SCS insertion costs), with the magnitude of reduction greater among those that met the primary endpoint.

“This analysis shows that among patients that start and continue SCS therapy for at least two years, a significant proportion were able to reduce and/or discontinue systemic opioid use and SCS does reduce total treatment cost relative to baseline,” concluded researchers..  —Edan Stanley