EPV018 - EDUCATION PREDICTS PAIN RELIEF OF SPINAL CORD STIMULATION (ID 291)
- Terje Kirketeig, Sweden
- Terje Kirketeig, Sweden
- Emma Söreskog, Sweden
- Trolle Jacobson, Sweden
- Rolf Karlsten, Sweden
- Peter Fritzell, Sweden
- Fredrik Borgström, Sweden
Abstract
Introduction
Multiple controlled trials have proven spinal cord stimulation (SCS) to be a safe and efficacious treatment for selected pain conditions. However, comprehensive real-world outcome studies with larger population samples are lacking. The Swedish research database for spinal cord stimulation (SWECOST) is a database assembled using patient-level data from Swedish national registers, including; in- and outpatient care, drug dispensations, socioeconomic data, and SCS-specific information from the local RAY database. The objective of this study was to assess; (1) long-term predictors of the patient-reported effect of stimulation (EoS) on pain relief and (2) risk of explantation due to insufficient analgesic effect.
Methods/Materials
Patients registered in RAY who received SCS treatment between 2009–2018 were included. The first analysis evaluated EoS on pain, collected at the first follow-up (3–24 months) using answers categorized in six levels, from worsened pain to no pain. Ordered logistic regression was used to determine predictors for EoS. The second analysis assessed predictors for the explantation of SCS due to insufficient analgesic effect, using a time-to-event analysis with first explantation due to insufficient analgesic effect as failure event. Cox proportional hazard regression was used in this analysis.
Results
In total, 404 patients were included. Three percent reported pain-free, 19% considerable, 35% acceptable, 40% some, and 3% no pain relief or worsened pain compared to before the SCS. Higher education (coef.=-1.350 to -0.819 depending on category, p<0.006) were significantly associated with a successful outcome contrary to being unemployed (coef.=0.648, p=0.012). Consuming ≥200 defined daily doses/year of opioids was associated with a less successful outcome (coef.=0.436, p=0.177). For the second analysis, the survival rate for explantation at 10 years was 79% (CI: 72%–84%). Being 60 years or older (hazard ratio (HR)=3.818, p=0.022) was associated with a higher risk of explantation.
Discussion
In a patient-reported outcome in a non-selective and clinically relevant population more than half of the patients reported acceptable to complete pain-free following SCS. Risk of explantation due to loss of effect in this study largely confirms prior real-world reports.
Conclusions
Socioeconomic status, and opioid consumption although non-significantly, affect analgesic effectiveness and risk of explantation, implicating the need for considering these factors in future studies.
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