Abstract
Introduction: Spinal cord stimulation (SCS) has been shown to reduce opioid use in patients with chronic back and leg pain. Studies report that SCS can help patients reduce or discontinue opioid medication, addressing a major public health challenge in chronic pain management. The PROSTIM study aims to explore whether distinct patient clusters respond differently to SCS in terms of reducing opioid consumption, focusing on the discontinuation of opioid after 6-12 months.
Materials / Methods: The PROSTIM study is a prospective, multicenter, observational study involving patients with Persistent Spinal Pain Syndrome (PSPS) type II. A total of 101 patients were included, with baseline data collected on demographics, opioid use, and other biopsychosocial factors. Patients received individualized counseling and gradual tapering support for their opioid reduction. Cluster analysis was performed to identify distinct patient subgroups. Next, logistic regression was conducted to estimate the likelihood that patients using weak or strong opioids at baseline would transition to either no opioid use or only WHO class I medications after SCS treatment.
Results
Two distinct patient clusters were identified (table 1). Cluster 1, characterized by higher baseline pain intensity, greater disability and low quality of life. In contract cluster 2 reported less severe symptoms with a persevered QOL. Logistic regression analysis revealed no significant difference between the clusters in terms of the expected probability of reducing opioid use to no opioids or only WHO class I medications. The expected probability of opioid reduction were 0,65 (95% CI 0,35 – 0,86) and 0,71 (95%CI 0,27 – 0,94) respectively after 6-12 months of SCS treatment.
Discussion: This finding supports the hypothesis that SCS may provide benefits in reducing opioid consumption across a wide spectrum of patients, irrespective of their initial pain profiles or levels of disability. The similar outcomes between the two clusters highlight that even patients with more severe baseline conditions can achieve important reductions in opioid use This has significant implications for clinical practice, as it indicates that SCS can be considered a viable treatment option for a wide range of patients suffering from chronic pain, without the need for extensive stratification based on initial pain severity or quality of life.
Conclusions: This study demonstrated the potential of SCS to significantly reduce opioid use in patients with PSPS type II, regardless of baseline patient characteristics, supporting its broad applicability in pain management.
Oral presentation.