EPV239 - THE LEEDS TEACHING HOSPITALS TRUST EXPERIENCE OF SPINAL CORD STIMULATION: A RETROSPECTIVE EVALUATION IN CHRONIC PAIN CONDITIONS (ID 282)
- Beatrice Bretherton, United Kingdom
- G. Baranidharan, United Kingdom
- Beatrice Bretherton, United Kingdom
- Tracey Crowther, United Kingdom
- Thomas Kay, United Kingdom
- Nathan Marsh, United Kingdom
- Bethan Roberts, United Kingdom
- Charlotte Romanis, United Kingdom
Abstract
Introduction
Since 1967, spinal cord stimulation (SCS) has been increasingly used in the treatment of chronic pain. Large numbers of patients are implanted with a SCS in the UK: around 34,000 patients per year. Approximately 180 of these are carried out in the Leeds Teaching Hospitals NHS Trust (LTHT). Most studies, typically prospective trials, have demonstrated that SCS is effective and safe in a number of diagnoses, including failed back surgery syndrome (1), failed neck surgery syndrome (2), complex regional pain syndrome (3), painful diabetic neuropathy (4), fibromyalgia (5) along with many others. Using real-world data, this study investigated the efficacy and complications associated with SCS in failed back surgery syndrome (FBSS) and chronic visceral pain in a teaching hospital.
Methods/Materials
This was a retrospective evaluation, with data collected from patients with failed back surgery syndrome or chronic visceral pain who received 10 kHz or BurstDR SCS from March 2012-March 2020 in LTHT. The following data were ascertained from paper files and hospital electronic records: gender, age, chronic pain diagnosis, SCS system, implant date, baseline and follow-up scores for average pain (visual analogue scale, VAS), worst pain (VAS) and health-related quality of life (EQ-5D), and the occurrence of revisions and explants. Data were statistically analysed by paired t-tests (or Wilcoxon signed-rank tests for non-normally distributed data). Descriptive statistics, counts and percentages were also generated.
Results
Four hundred and forty-five patients with FBSS or chronic visceral pain received fully implanted 10 kHz or burst SCS. Eleven patients were waiting for their first follow-up and three patients were lost to follow-up. Fifty-one patients had an explantation and six were waiting for explantation of their system. This resulted in a final sample of 374 patients. Average pain (p < 0.001), worst pain (p < 0.001) and QoL (p < 0.001) were significantly improved at follow-up compared to baseline. The mean (SD) change in average pain, worst pain and QoL were -2.35 (2.36 cm), -2.04 (2.33 cm) and 0.30 (0.44) respectively. Remission (0-3cm average pain VAS, (6)) occurred in 23% (98 of 421) of patients and 27% (108 of 398) reported reductions ≥50% in average pain at follow-up. Fifty-three patients (of 374, 14%) underwent a revision with IPG or anchor site pain being the most common reason for revision (n = 27). In total, 51 (of 445, 11%) patients underwent a full system explantation. Insufficient pain relief was the most common reason for explant (n = 42), followed by infection (n = 8) and requiring an MRI (n = 2). IPG site pain was cited as a secondary influential factor for explantation in seven cases.
Discussion
Findings demonstrated that SCS in FBSS and chronic visceral pain were effective at reducing pain and improving QoL. Importantly, an assessment of surgical revisions and explants showed this treatment is safe in these conditions.
Conclusions
By using real-world data, it is hoped that findings from this retrospective study will broaden insight into the clinical practice of SCS in FBSS and chronic visceral pain.
References
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