Department of Medical Information, GHU Paris Psychiatrie & Neurosciences, Paris, France.
Department of Anesthesia, GHU Paris Psychiatrie & Neurosciences, Paris, France.
Pain Pract. 2023 Jun;23(5):493-500. doi: 10.1111/papr.13205. Epub 2023 Jan 27.
Chronic pain has a substantial negative impact on work-related outcomes, which underlines the importance of interventions to reduce the burden. Spinal cord stimulation (SCS) efficiently relieves pain in specific chronic pain syndromes and is recommended for treating failed back surgery syndrome (FBSS) or post-surgical chronic back pain that is refractory to other treatments. To examine the impact of SCS in patients with FBSS on the return to work (RTW), we determined the RTW rate and the factors positively associated with the RTW.
Among 106 patients with FBSS who benefitted from SCS at a single institution in France between September 1999 and March 2010, we retrospectively included 59 who had stopped work at the time of SCS because of disability or sick leave and evaluated the RTW (rate and predictors, estimating odds ratios [ORs] and 95% confidence intervals [CIs]).
The mean (SD) post-surgery follow-up for the 59 patients (34 men; mean [SD] age 46.9 [7.4] years) was 7.5 (3.6) years (range 5-15). The RTW rate was 30.5%, with a median [IQR] recovery time of 5.5 months [3-8.5]. RTW was improved with functional improvement evolution (OR 1.1, 95% CI [1.01-1.1], p = 0.02) and was reduced with unemployment > 3 years (OR 0.1, 95% CI [0.01-0.7], p = 0.02).
Our protocol for SCS for patients with FBSS, including a strict selection of patients and a multidisciplinary approach, led to good results, especially for the RTW. RTW should be a therapeutic goal, directly affecting indirect costs related to FBSS.
慢性疼痛对与工作相关的结果有重大负面影响，这凸显了干预措施减轻负担的重要性。脊髓刺激 (SCS) 可有效缓解特定慢性疼痛综合征的疼痛，并且推荐用于治疗失败的腰椎手术综合征 (FBSS) 或对其他治疗方法有抗药性的手术后慢性腰痛。为了研究 SCS 对 FBSS 患者重返工作岗位 (RTW) 的影响，我们确定了 RTW 率和与 RTW 呈正相关的因素。
在法国的一家机构，1999 年 9 月至 2010 年 3 月期间，106 名 FBSS 患者因残疾或病假而停止工作并接受了 SCS 治疗，我们回顾性纳入了其中 59 名患者，评估了 RTW（比率和预测因素，估计优势比[OR]和 95%置信区间[CI]）。
59 名患者（34 名男性；平均[标准差]年龄 46.9[7.4]岁）手术后的平均（标准差）随访时间为 7.5（3.6）年（范围 5-15 年）。RTW 率为 30.5%，中位（IQR）恢复时间为 5.5 个月[3-8.5 个月]。RTW 随着功能改善的演变而改善（OR 1.1，95%CI[1.01-1.1]，p=0.02），随着失业>3 年而降低（OR 0.1，95%CI[0.01-0.7]，p=0.02）。
我们为 FBSS 患者制定的 SCS 方案，包括对患者的严格选择和多学科方法，取得了良好的效果，尤其是在 RTW 方面。RTW 应该是一个治疗目标，直接影响与 FBSS 相关的间接成本。
