Department of Rehabilitation, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
Department of Rehabilitation, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland; Neurosurgery, Kuopio University Hospital (KUH) University of Eastern Finland, Kuopio, Finland.
Pain Physician. 2022 Aug;25(5):E739-E748.
Spinal 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.
We studied the effect of retirement on opioid use in patients with chronic pain after failed back surgery.
A retrospective study design.
The study was conducted at Kuopio University Hospital.
The 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).
During 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.
No structured questionnaires were used in this study. Also, many underlying factors contributing to chronic pain were missing.
DP did not reduce the use of opioids in patients with FBSS. Opioid doses were lower and dose escalation less steep with continuous SCS therapy.
脊髓刺激（SCS）是治疗失败的腰椎手术综合征（FBSS）的有效方法。在 FBSS 患者中，即使在尝试 SCS 之前，通常也会开始使用阿片类药物。
我们研究了腰椎手术后慢性疼痛患者退休对阿片类药物使用的影响。
回顾性研究设计。
该研究在库奥皮奥大学医院进行。
研究组包括 1996 年 1 月 1 日至 2014 年 12 月 31 日期间在库奥皮奥大学医院神经外科接受 SCS 试验或植入治疗 FBSS 的 230 名患者。从社会保险机构获得所有处方阿片类药物及其每日规定剂量的购买情况以及工作能力数据。患者分为 3 组：仅进行 SCS 试验、永久植入 SCS 和植入后 SCS 被移除。我们分析了这些组在残疾养老金（DP）开始前 2 年和开始后 2 年之间阿片类药物使用的差异。
在随访期间，共有 60 名患者获得 DP。在 DP 前一年，大多数患者使用阿片类药物（n = 43，72%），并且在退休后的一年随访期间，使用者数量略有增加（n = 46，77%）。在永久性植入 SCS 组中，退休后强阿片类药物使用者的数量减少。大多数患者使用中等剂量（0.1-10.5 吗啡毫克当量/天）。退休似乎中断了所有组的剂量升级，但随着随访的继续，剂量进一步增加。
本研究未使用结构化问卷，也未考虑许多导致慢性疼痛的潜在因素。
DP 并未减少 FBSS 患者阿片类药物的使用。持续 SCS 治疗时，阿片类药物剂量较低，剂量升级幅度较小。
