CC and its protocolized workflow provides for meaningful pain relief and opiate reduction

MMS and its protocolized workflow provides for meaningful pain relief and opiate reduction

Duke Neurosurgery

Sarah E Hodges, BA; Shervin Rahimpour, MD; Luis A Antezana, BS; Abena A Ansah-Yeboah, BS; Rajeev Dharmapurikar, MS; John Hatehway, MD; Michael Warrick, MD; Scott Berlin, MD; Benjamin Seeman, DO; Shivanand P Lad, MD, PhD

Key Results

79%

Patients Experience 50%+ Pain Relief

52%

Patients Reduced Use of ‘As Needed’ Medications

87%

Would Recommend the Same Procedure

Introduction

  • Various new waveforms for spinal cord stimulation (SCS) have emerged in recent years, but with limited data supporting their utility in a real-world clinical setting.

  • We report real-world results of a protocolized workflow algorithm that allows for high dose (HD) and low dose (LD) neurostimulation in patients with chronic pain undergoing SCS trial or permanent procedures

Objectives

  • ​To assess if a protocolized workflow algorithm that allows for high dose (HD) and low dose (LD) Spinal Cord Stimulation (SCS) has utility and efficacy in a real-world clinical setting.

  • To determine if a protocolized workflow algorithm that offers HD and LD SCS can provide meaningful pain relief.

  • To evaluate whether a protocolized workflow algorithm that offers HD and LD SCS may hold promise for facilitating an opiate reduction in patients with chronic pain.

Methods

  • Prospective data was collected using the Manage My Surgery mobile device platform in patients undergoing Medtronic SCS trial and permanent implant procedures.

  • E-consent was obtained through the HIPAA compliant, mobile software platform.

  • All data were de-identified, aggregated, and analyzed.

Results

  • In total, 104 patients (37 trial SCS and 67 permanent SCS) participated.

  • For SCS trial and permanent procedures, the protocolized workflow algorithm resulted in a 91% trial success rate with >50% pain relief.

  • At long-term follow-up (3 to 12 months), 86% of permanent SCS patients reported they were getting the same or more relief as during their SCS trial.

  • For permanent SCS patients, 79% reported >50% improvement in overall pain and 58% had >50% improvement in low back pain.

  • The protocolized workflow algorithm resulted in a 37% ‘remitter rate’, with these patients reporting themselves to be essentially pain-free (VAS 0-3).

  • Importantly, 52% of permanent implant patients stopped or reduced their ‘as needed’ pain medications by >50%.

  • Additionally, 87% would recommend the same procedure to a friend or family member, 87% found device charging ‘easy’ or ‘very easy’ and 66% reported charing a few times a week or weekly.

Conclusion

  • A protocolized workflow algorithm that allows for high dose (HD) and low dose (LD) Spinal Cord Stimulation (SCS) appears to have robust utility and efficacy in a real-world clinical setting.

  • A protocolized workflow algorithm that offers HD and LD SCS can provide meaningful pain relief.

  • A protocolized workflow algorithm that offers HD and LD SCS shows great promise for facilitating an opiate reduction in patients with chronic pain; an intriguing possibility, particularly in light of the current opioid epidemic, that merits further evaluation, with an RCT and extended long-term follow-up in progress.