Clinical practice patterns of opioid prescribing by physicians performing percutaneous spinal cord stimulation trials and implants

Keisha Dodman, MD; Thomas T. Simopoulos, MD; Lynn Kohan, MD; Jamal Hasoon, MD; Jatinder Gill, MD

doi:10.5055/jom.2023.0772

Authors

Keisha Dodman, MD https://orcid.org/0000-0001-6732-0242
Thomas T. Simopoulos, MD https://orcid.org/0000-0001-5775-7635
Lynn Kohan, MD
Jamal Hasoon, MD
Jatinder Gill, MD

DOI:

https://doi.org/10.5055/jom.2023.0772

Keywords:

spinal cord stimulation, neuromodulation, perioperative opioids, opioid reduction, chronic opioid therapy

Abstract

Background: Spinal cord stimulation (SCS) is an effective therapy for neuropathic pain. Outcomes of SCS may be influenced by peri-implant opioid management; however, to date, standard practices of opioid management in this scenario remain undefined and unreported.

Methods: A survey inquiring SCS management practices in the peri-implant period was sent to the members of the Spine Intervention Society and the American Society of Regional Anesthesia. The results of three questions pertaining to peri-implant opioid management are presented here.

Results: For each of the three questions examined, there were between 181 and 195 responses. Among respondents, 40 percent encouraged reduction of opioids prior to SCS trial, and 17 percent mandated reduction. After a SCS trial, 87 percent of respondents did not provide any additional opioids for periprocedure pain. After implant, the majority of respondents provided 1-7 days of opioids for post-operative pain.

Conclusion: Based upon survey results and current literature, it is advisable to recommend or attempt opioid reduction before SCS and to not provide additional opioid for post-operative pain after trial lead insertion. Routine prescribing for the pain of the SCS implant beyond 7 days is not favored.

Author Biographies

Keisha Dodman, MD

Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; Department of Anesthesiology, Newton-Wellesley Hospital, Newton, Massachusetts

Thomas T. Simopoulos, MD

Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

Lynn Kohan, MD

Department of Anesthesiology, Division of Pain Medicine, University of Virginia Health System, Charlottesville, Virginia

Jamal Hasoon, MD

Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; UTHealth McGovern Medical School, Department of Anesthesia and Pain Medicine, Houston, Texas

Jatinder Gill, MD

Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

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