Jacobs Benjamin M, Kerr Marcel S, Broadnax John P, Anderson Eric
Anne Burnett Marion School of Medicine at Texas Christian University, 4055 International Plaza, Fort Worth, TX, 76109, USA.
School of Biomedical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA.
Interv Pain Med. 2023 Aug 12;2(3):100275. doi: 10.1016/j.inpm.2023.100275. eCollection 2023 Sep.
Chronic Pain is a prevalent condition that affects many people in the United States. Spinal Cord Stimulation (SCS) has been documented to help reduce perceived pain; however, few studies have analyzed the impact of perceived pain on opioid consumption before and after SCS.
This retrospective cohort study aimed to evaluate the impact of spinal cord stimulation on opioid consumption after permanent SCS implant.
This IRB-approved retrospective single-center study investigated the opioid consumption of 26 adults at three different times: (1) Initial date of service-baseline- (2) SCS implant date, and (3) 6 months post-SCS implant date. Mean opioid consumption was calculated over the month prior and after to visit of (1), (2), and (3) to generate 3 separate month averages. Opioid consumptions were measured using Morphine Milligram Equivalents (MME). To determine the difference in MME consumption from baseline to permanent SCS implantation, we conducted a series of paired-sample -tests.
Patients' MME significantly decreased from baseline (M = 52.63, SD = 45.07) to 6-months post-SCS implantation (M = 24.64, SD = 31.97, t (25) = 4.29, p < .001). The effect of this difference was large (d = 0.84). Whereas patients' morphine equivalents decreased from date of SCS implantation (M = 35.73, SD = 52.78) to 6-months post-SCS implantation (M = 24.64, SD = 31.97), this difference was not significant (t (25) = 1.66, p = .11) but yielded a small effect size (d = 0.34).
DISCUSSIONS/CONCLUSION: In our study, patients using opioids for non-cancer pain management, SCS moderated the perception of pain neurocircuitry and noxious stimuli-manifestation, resulting in a reduced sense of pain and decreased opioid usage.
慢性疼痛在美国是一种普遍存在的疾病，影响着很多人。脊髓刺激（SCS）已被证明有助于减轻感知到的疼痛；然而，很少有研究分析在脊髓刺激前后感知到的疼痛对阿片类药物消费的影响。
这项回顾性队列研究旨在评估永久性脊髓刺激植入后对阿片类药物消费的影响。
这项经机构审查委员会批准的回顾性单中心研究在三个不同时间点调查了26名成年人的阿片类药物消费情况：（1）首次就诊日期——基线期——（2）脊髓刺激植入日期，以及（3）脊髓刺激植入后6个月。计算在（1）、（2）和（3）就诊前一个月和之后一个月的平均阿片类药物消费量，以得出3个单独的月平均值。使用吗啡毫克当量（MME）来衡量阿片类药物的消费量。为了确定从基线到永久性脊髓刺激植入时MME消费量的差异，我们进行了一系列配对样本t检验。
患者的MME从基线期（M = 52.63，标准差 = 45.07）显著下降至脊髓刺激植入后6个月（M = 24.64，标准差 = 31.97，t（25） = 4.29，p <.001）。这种差异的影响很大（d = 0.84）。虽然患者的吗啡当量从脊髓刺激植入日期（M = 35.73，标准差 = 52.78）下降至脊髓刺激植入后6个月（M = 24.64，标准差 = 31.97），但这种差异不显著（t（25） = 1.66，p = 0.11），但效应量较小（d = 0.34）。
讨论/结论：在我们的研究中，对于使用阿片类药物进行非癌性疼痛管理的患者，脊髓刺激调节了疼痛神经回路和有害刺激的表现，从而减轻了疼痛感并减少了阿片类药物的使用。
