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Treatment of a Large Cohort of Veterans Experiencing Musculoskeletal Disorders with Spinal Cord Stimulation in the Veterans Health Administration: Veteran Characteristics and Outcomes

Authors Wandner LD, Fenton BT, Goulet JL, Carroll CM, Heapy A, Higgins DM, Bair MJ, Sandbrink F, Kerns RD

Received 9 December 2019

Accepted for publication 7 May 2020

Published 7 July 2020 Volume 2020:13 Pages 1687—1697


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr E Alfonso Romero-Sandoval

Laura D Wandner,1,2 Brenda T Fenton,3 Joseph L Goulet,3,4 Constance M Carroll,5 Alicia Heapy,3,6 Diana M Higgins,7,8 Matthew J Bair,9– 11 Friedhelm Sandbrink,12,13 Robert D Kerns3,6,14,15

1National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA; 2Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, USA; 3Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA; 4Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA; 5Yale University AIDS Program, New Haven, CT, USA; 6Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; 7VA Boston Healthcare System, Boston, MA, USA; 8Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; 9VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; 10Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; 11Regenstrief Institute, Indianapolis, IN, USA; 12Department of Neurology, VA Medical Center, Washington, DC, USA; 13Department of Neurology, Georgetown University, Washington, DC, USA; 14Department of Neurology, Yale School of Medicine, New Haven, CT, USA; 15Department of Psychology, Yale University, New Haven, CT, USA

Correspondence: Laura D Wandner
National Institutes of Health (NIH), 10 Center Dr, Bethesda, MD 20814, USA

Objective: Spinal cord stimulator (SCS) implantation is used to treat chronic pain, including painful musculoskeletal disorders (MSDs). This study examined the characteristics and outcomes of veterans receiving SCSs in Veterans Health Administration (VHA) facilities.
Methods: The sample was drawn from the MSD Cohort and limited to three MSDs with the highest number of implants (N=815,475). There were 1490 veterans with these conditions who received SCS implants from 2000 to 2012, of which 95% (n=1414) had pain intensity numeric rating scale (NRS) data both pre- and post-implant.
Results: Veterans who were 35– 44 years old, White, and married reported higher pain NRS ratings, had comorbid inclusion diagnoses, had no medical comorbidities, had a BMI 25– 29.9, or had a depressive disorder diagnosis were more likely to receive an SCS. Veterans 55+ years old or with an alcohol or substance use disorder were less likely to receive an SCS. Over 90% of those receiving an SCS were prescribed opioids in the year prior to implant. Veterans who had a presurgical pain score ≥ 4 had a clinically meaningful decrease in their pain score in the year following their 90-day recovery period (Day 91– 456) greater than expected by chance alone. Similarly, there was a significant decrease in the percent of veterans receiving opioid therapy (92.4% vs 86.6%, p< 0.0001) and a significant overall decrease in opioid dose [morphine equivalent dose per day (MEDD) =26.48 vs MEDD=22.59, p< 0.0003].
Conclusion: Results offer evidence of benefit for some veterans with the examined conditions. Given known risks of opioid therapy, the reduction is an important potential benefit of SCS implants.

Keywords: spinal cord stimulator, musculoskeletal disorders, veterans, outcomes, opioids

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