Association of Spinal Cord Stimulator Implantation With Persistent Opioid Use in Patients With Postlaminectomy Syndrome
The results of studies evaluating spinal cord stimulation (SCS) for postlaminectomy syndrome (PLS) have yielded mixed results. This has led to an increased emphasis on objective outcome measures such as opioid prescribing. To determine the association between SCS and long-term opioid therapy (LOT) f...
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| Veröffentlicht in: | JAMA network open 2022-01, Vol.5 (1), p.e2145876 |
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| description | The results of studies evaluating spinal cord stimulation (SCS) for postlaminectomy syndrome (PLS) have yielded mixed results. This has led to an increased emphasis on objective outcome measures such as opioid prescribing.
To determine the association between SCS and long-term opioid therapy (LOT) for PLS.
In this cohort study, adults with PLS were identified using the TriNetx Diamond Network and separated based on whether they underwent SCS. Patients were stratified according to baseline opioid use (opioid-naive or receiving LOT) and subsequent opioid therapy over the 12-month period ranging from 3 to 15 months post-SCS implantation or post-PLS index date. Statistical analysis was performed from June to December 2021.
SCS.
The main outcome was cessation of opioid use among patients receiving LOT or abstinence from opioids among opioid-naive patients. Opioid-naive patients were defined as those receiving at most 2 opioid prescriptions per year, and patients on LOT were those receiving at least 6 opioid prescriptions per year.
Among 552 937 eligible patients treated between December 2015 and May 2021, 26 179 with PLS received an SCS implant. The median (IQR) patient age was 60 (51-69) years; 305 802 patients (55.3%) were female. Among those reporting racial identify (37.0% [204 758 patients]), 9.3% (18 971 patients) were African American, 0.3% (648 patients) were Asian, and 90.4% (185 139 patients) were White. Compared with those who did not receive an SCS, individuals who received an SCS were more likely to be using opioids preimplantation (mean [SD] prescriptions: 4.3 [8.5] vs 4.1 [9.3]; P |
| doi_str_mv | 10.1001/jamanetworkopen.2021.45876 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8804916</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2667743444</sourcerecordid><originalsourceid>FETCH-LOGICAL-a473t-dc0f143809f606dd37f3c060d5c0c297d18b318efae42c598d7edcb828647ae63</originalsourceid><addsrcrecordid>eNpdkV1PHCEUhklTU431Lxii17s9DAwwXpiYTf1ITDRZjZeEBaaynYEpsDX7753trkZ7BeE85-XAg9AJgSkBID-WutfBlZeYfsfBhWkFFZmyWgr-BR1UtWATKqH--mG_j45yXgJABYQ2vP6G9mkNTVMzfoBeLnKOxuviY8CxxfPBB93hWUwWz4vvV50uMeGbfuh0KFvsyZdnfO9S9rm4UPDd4KO3-DE77AO-H6HxNO-wmEunex-cKbFf4_k62BR79x3ttbrL7mi3HqLHy58Ps-vJ7d3VzezidqKZoGViDbSEja9oWg7cWipaaoCDrQ2YqhGWyAUl0rXascrUjbTCWbOQleRMaMfpITrf5g6rRT-WxsmS7tSQfK_TWkXt1edK8M_qV_yrpATWkE3A6S4gxT8rl4taxlUa_yirinMhGGWMjdTZljIp5pxc-34DAbXxpv7zpjbe1D9vY_PxxxnfW98s0VfV5Z0b</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2667743444</pqid></control><display><type>article</type><title>Association of Spinal Cord Stimulator Implantation With Persistent Opioid Use in Patients With Postlaminectomy Syndrome</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Vu, To-Nhu ; Khunsriraksakul, Chachrit ; Vorobeychik, Yakov ; Liu, Alison ; Sauteraud, Renan ; Shenoy, Ganesh ; Liu, Dajiang J ; Cohen, Steven P</creator><creatorcontrib>Vu, To-Nhu ; Khunsriraksakul, Chachrit ; Vorobeychik, Yakov ; Liu, Alison ; Sauteraud, Renan ; Shenoy, Ganesh ; Liu, Dajiang J ; Cohen, Steven P</creatorcontrib><description>The results of studies evaluating spinal cord stimulation (SCS) for postlaminectomy syndrome (PLS) have yielded mixed results. This has led to an increased emphasis on objective outcome measures such as opioid prescribing.
To determine the association between SCS and long-term opioid therapy (LOT) for PLS.
In this cohort study, adults with PLS were identified using the TriNetx Diamond Network and separated based on whether they underwent SCS. Patients were stratified according to baseline opioid use (opioid-naive or receiving LOT) and subsequent opioid therapy over the 12-month period ranging from 3 to 15 months post-SCS implantation or post-PLS index date. Statistical analysis was performed from June to December 2021.
SCS.
The main outcome was cessation of opioid use among patients receiving LOT or abstinence from opioids among opioid-naive patients. Opioid-naive patients were defined as those receiving at most 2 opioid prescriptions per year, and patients on LOT were those receiving at least 6 opioid prescriptions per year.
Among 552 937 eligible patients treated between December 2015 and May 2021, 26 179 with PLS received an SCS implant. The median (IQR) patient age was 60 (51-69) years; 305 802 patients (55.3%) were female. Among those reporting racial identify (37.0% [204 758 patients]), 9.3% (18 971 patients) were African American, 0.3% (648 patients) were Asian, and 90.4% (185 139 patients) were White. Compared with those who did not receive an SCS, individuals who received an SCS were more likely to be using opioids preimplantation (mean [SD] prescriptions: 4.3 [8.5] vs 4.1 [9.3]; P < .001) but less likely to be using opioids after SCS implantation (mean [SD] prescriptions: 3.8 [8.2] vs 4.0 [9.4]; P = .006). In the 12-month study period, similar proportions in the SCS and no-SCS groups receiving baseline LOT remained on LOT (70.3% [n = 74 585] vs 69.2% [n = 3882], respectively; P = .10). In opioid-naive patients, SCS was associated with a small decreased likelihood of patients subsequently receiving LOT (7.6% vs 7.0%; difference, -0.6% [95% CI, -1.0% to -0.2%]; P = .003). In multivariable analysis, SCS was associated with an increased likelihood of not being on opioids in both opioid-naive (adjusted odds ratio [OR], 0.90 [95% CI, 0.85-0.96]; P < .001) and LOT patients (adjusted OR, 0.93 [95% CI, 0.88-0.99]; P = .02). White patients were significantly more likely to be diagnosed with PLS (ie, underwent surgery) (90.4% vs 85.2%; difference, 5.2% [95% CI, 5.1%-5.4%]; P < .001) and receive an SCS (93.7% vs 90.3%; difference, 3.4% [95% CI, 2.9% to 4.0%]; P < .001) than patients of other racial identities.
These findings suggest that under real-life conditions, SCS was associated with small, clinically questionable associations with opioid discontinuation and not starting opioids in the context of PLS.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2021.45876</identifier><identifier>PMID: 35099546</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Aged ; Analgesics, Opioid - therapeutic use ; Anesthesiology ; Drug Prescriptions - statistics & numerical data ; Failed Back Surgery Syndrome - therapy ; Female ; Humans ; Laminectomy - adverse effects ; Male ; Middle Aged ; Multivariate Analysis ; Narcotics ; Odds Ratio ; Online Only ; Original Investigation ; Postoperative Period ; Practice Patterns, Physicians' - statistics & numerical data ; Prosthesis Implantation ; Spinal cord ; Spinal Cord Stimulation - statistics & numerical data</subject><ispartof>JAMA network open, 2022-01, Vol.5 (1), p.e2145876</ispartof><rights>2022. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2022 Vu TN et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a473t-dc0f143809f606dd37f3c060d5c0c297d18b318efae42c598d7edcb828647ae63</citedby><cites>FETCH-LOGICAL-a473t-dc0f143809f606dd37f3c060d5c0c297d18b318efae42c598d7edcb828647ae63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,864,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35099546$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vu, To-Nhu</creatorcontrib><creatorcontrib>Khunsriraksakul, Chachrit</creatorcontrib><creatorcontrib>Vorobeychik, Yakov</creatorcontrib><creatorcontrib>Liu, Alison</creatorcontrib><creatorcontrib>Sauteraud, Renan</creatorcontrib><creatorcontrib>Shenoy, Ganesh</creatorcontrib><creatorcontrib>Liu, Dajiang J</creatorcontrib><creatorcontrib>Cohen, Steven P</creatorcontrib><title>Association of Spinal Cord Stimulator Implantation With Persistent Opioid Use in Patients With Postlaminectomy Syndrome</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>The results of studies evaluating spinal cord stimulation (SCS) for postlaminectomy syndrome (PLS) have yielded mixed results. This has led to an increased emphasis on objective outcome measures such as opioid prescribing.
To determine the association between SCS and long-term opioid therapy (LOT) for PLS.
In this cohort study, adults with PLS were identified using the TriNetx Diamond Network and separated based on whether they underwent SCS. Patients were stratified according to baseline opioid use (opioid-naive or receiving LOT) and subsequent opioid therapy over the 12-month period ranging from 3 to 15 months post-SCS implantation or post-PLS index date. Statistical analysis was performed from June to December 2021.
SCS.
The main outcome was cessation of opioid use among patients receiving LOT or abstinence from opioids among opioid-naive patients. Opioid-naive patients were defined as those receiving at most 2 opioid prescriptions per year, and patients on LOT were those receiving at least 6 opioid prescriptions per year.
Among 552 937 eligible patients treated between December 2015 and May 2021, 26 179 with PLS received an SCS implant. The median (IQR) patient age was 60 (51-69) years; 305 802 patients (55.3%) were female. Among those reporting racial identify (37.0% [204 758 patients]), 9.3% (18 971 patients) were African American, 0.3% (648 patients) were Asian, and 90.4% (185 139 patients) were White. Compared with those who did not receive an SCS, individuals who received an SCS were more likely to be using opioids preimplantation (mean [SD] prescriptions: 4.3 [8.5] vs 4.1 [9.3]; P < .001) but less likely to be using opioids after SCS implantation (mean [SD] prescriptions: 3.8 [8.2] vs 4.0 [9.4]; P = .006). In the 12-month study period, similar proportions in the SCS and no-SCS groups receiving baseline LOT remained on LOT (70.3% [n = 74 585] vs 69.2% [n = 3882], respectively; P = .10). In opioid-naive patients, SCS was associated with a small decreased likelihood of patients subsequently receiving LOT (7.6% vs 7.0%; difference, -0.6% [95% CI, -1.0% to -0.2%]; P = .003). In multivariable analysis, SCS was associated with an increased likelihood of not being on opioids in both opioid-naive (adjusted odds ratio [OR], 0.90 [95% CI, 0.85-0.96]; P < .001) and LOT patients (adjusted OR, 0.93 [95% CI, 0.88-0.99]; P = .02). White patients were significantly more likely to be diagnosed with PLS (ie, underwent surgery) (90.4% vs 85.2%; difference, 5.2% [95% CI, 5.1%-5.4%]; P < .001) and receive an SCS (93.7% vs 90.3%; difference, 3.4% [95% CI, 2.9% to 4.0%]; P < .001) than patients of other racial identities.
These findings suggest that under real-life conditions, SCS was associated with small, clinically questionable associations with opioid discontinuation and not starting opioids in the context of PLS.</description><subject>Aged</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Anesthesiology</subject><subject>Drug Prescriptions - statistics & numerical data</subject><subject>Failed Back Surgery Syndrome - therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Laminectomy - adverse effects</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Narcotics</subject><subject>Odds Ratio</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Postoperative Period</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Prosthesis Implantation</subject><subject>Spinal cord</subject><subject>Spinal Cord Stimulation - statistics & numerical data</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkV1PHCEUhklTU431Lxii17s9DAwwXpiYTf1ITDRZjZeEBaaynYEpsDX7753trkZ7BeE85-XAg9AJgSkBID-WutfBlZeYfsfBhWkFFZmyWgr-BR1UtWATKqH--mG_j45yXgJABYQ2vP6G9mkNTVMzfoBeLnKOxuviY8CxxfPBB93hWUwWz4vvV50uMeGbfuh0KFvsyZdnfO9S9rm4UPDd4KO3-DE77AO-H6HxNO-wmEunex-cKbFf4_k62BR79x3ttbrL7mi3HqLHy58Ps-vJ7d3VzezidqKZoGViDbSEja9oWg7cWipaaoCDrQ2YqhGWyAUl0rXascrUjbTCWbOQleRMaMfpITrf5g6rRT-WxsmS7tSQfK_TWkXt1edK8M_qV_yrpATWkE3A6S4gxT8rl4taxlUa_yirinMhGGWMjdTZljIp5pxc-34DAbXxpv7zpjbe1D9vY_PxxxnfW98s0VfV5Z0b</recordid><startdate>20220104</startdate><enddate>20220104</enddate><creator>Vu, To-Nhu</creator><creator>Khunsriraksakul, Chachrit</creator><creator>Vorobeychik, Yakov</creator><creator>Liu, Alison</creator><creator>Sauteraud, Renan</creator><creator>Shenoy, Ganesh</creator><creator>Liu, Dajiang J</creator><creator>Cohen, Steven P</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope></search><sort><creationdate>20220104</creationdate><title>Association of Spinal Cord Stimulator Implantation With Persistent Opioid Use in Patients With Postlaminectomy Syndrome</title><author>Vu, To-Nhu ; Khunsriraksakul, Chachrit ; Vorobeychik, Yakov ; Liu, Alison ; Sauteraud, Renan ; Shenoy, Ganesh ; Liu, Dajiang J ; Cohen, Steven P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a473t-dc0f143809f606dd37f3c060d5c0c297d18b318efae42c598d7edcb828647ae63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Anesthesiology</topic><topic>Drug Prescriptions - statistics & numerical data</topic><topic>Failed Back Surgery Syndrome - therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Laminectomy - adverse effects</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Narcotics</topic><topic>Odds Ratio</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Postoperative Period</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Prosthesis Implantation</topic><topic>Spinal cord</topic><topic>Spinal Cord Stimulation - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vu, To-Nhu</creatorcontrib><creatorcontrib>Khunsriraksakul, Chachrit</creatorcontrib><creatorcontrib>Vorobeychik, Yakov</creatorcontrib><creatorcontrib>Liu, Alison</creatorcontrib><creatorcontrib>Sauteraud, Renan</creatorcontrib><creatorcontrib>Shenoy, Ganesh</creatorcontrib><creatorcontrib>Liu, Dajiang J</creatorcontrib><creatorcontrib>Cohen, Steven P</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vu, To-Nhu</au><au>Khunsriraksakul, Chachrit</au><au>Vorobeychik, Yakov</au><au>Liu, Alison</au><au>Sauteraud, Renan</au><au>Shenoy, Ganesh</au><au>Liu, Dajiang J</au><au>Cohen, Steven P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Spinal Cord Stimulator Implantation With Persistent Opioid Use in Patients With Postlaminectomy Syndrome</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2022-01-04</date><risdate>2022</risdate><volume>5</volume><issue>1</issue><spage>e2145876</spage><pages>e2145876-</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>The results of studies evaluating spinal cord stimulation (SCS) for postlaminectomy syndrome (PLS) have yielded mixed results. This has led to an increased emphasis on objective outcome measures such as opioid prescribing.
To determine the association between SCS and long-term opioid therapy (LOT) for PLS.
In this cohort study, adults with PLS were identified using the TriNetx Diamond Network and separated based on whether they underwent SCS. Patients were stratified according to baseline opioid use (opioid-naive or receiving LOT) and subsequent opioid therapy over the 12-month period ranging from 3 to 15 months post-SCS implantation or post-PLS index date. Statistical analysis was performed from June to December 2021.
SCS.
The main outcome was cessation of opioid use among patients receiving LOT or abstinence from opioids among opioid-naive patients. Opioid-naive patients were defined as those receiving at most 2 opioid prescriptions per year, and patients on LOT were those receiving at least 6 opioid prescriptions per year.
Among 552 937 eligible patients treated between December 2015 and May 2021, 26 179 with PLS received an SCS implant. The median (IQR) patient age was 60 (51-69) years; 305 802 patients (55.3%) were female. Among those reporting racial identify (37.0% [204 758 patients]), 9.3% (18 971 patients) were African American, 0.3% (648 patients) were Asian, and 90.4% (185 139 patients) were White. Compared with those who did not receive an SCS, individuals who received an SCS were more likely to be using opioids preimplantation (mean [SD] prescriptions: 4.3 [8.5] vs 4.1 [9.3]; P < .001) but less likely to be using opioids after SCS implantation (mean [SD] prescriptions: 3.8 [8.2] vs 4.0 [9.4]; P = .006). In the 12-month study period, similar proportions in the SCS and no-SCS groups receiving baseline LOT remained on LOT (70.3% [n = 74 585] vs 69.2% [n = 3882], respectively; P = .10). In opioid-naive patients, SCS was associated with a small decreased likelihood of patients subsequently receiving LOT (7.6% vs 7.0%; difference, -0.6% [95% CI, -1.0% to -0.2%]; P = .003). In multivariable analysis, SCS was associated with an increased likelihood of not being on opioids in both opioid-naive (adjusted odds ratio [OR], 0.90 [95% CI, 0.85-0.96]; P < .001) and LOT patients (adjusted OR, 0.93 [95% CI, 0.88-0.99]; P = .02). White patients were significantly more likely to be diagnosed with PLS (ie, underwent surgery) (90.4% vs 85.2%; difference, 5.2% [95% CI, 5.1%-5.4%]; P < .001) and receive an SCS (93.7% vs 90.3%; difference, 3.4% [95% CI, 2.9% to 4.0%]; P < .001) than patients of other racial identities.
These findings suggest that under real-life conditions, SCS was associated with small, clinically questionable associations with opioid discontinuation and not starting opioids in the context of PLS.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>35099546</pmid><doi>10.1001/jamanetworkopen.2021.45876</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | JAMA network open, 2022-01, Vol.5 (1), p.e2145876 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Analgesics, Opioid - therapeutic use Anesthesiology Drug Prescriptions - statistics & numerical data Failed Back Surgery Syndrome - therapy Female Humans Laminectomy - adverse effects Male Middle Aged Multivariate Analysis Narcotics Odds Ratio Online Only Original Investigation Postoperative Period Practice Patterns, Physicians' - statistics & numerical data Prosthesis Implantation Spinal cord Spinal Cord Stimulation - statistics & numerical data |
| title | Association of Spinal Cord Stimulator Implantation With Persistent Opioid Use in Patients With Postlaminectomy Syndrome |
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