Moreover, opioid use for chronic pain conditions like CLBP can cause tolerance, hyperalgesia, misuse, abuse and diversion 24, 25, 26, 27. In addition, opioids have well-described short and long-term side effects such as constipation, nausea, vomiting, sedation, dizziness, respiratory depression, hormonal imbalance, changes in immune response and physical dependence opioid overdose deaths are mainly due to acute respiratory depression caused by opioids 21, 22, 23. Limited head-to-head evidence suggests opioids to be more effective than naproxen or placebo for relieving CLBP 17, 18, but the average effect is little more than a 10-mm reduction on a 100-mm visual analog scale (VAS), a decrease that is not considered to be clinically meaningful 19, 20. Of these, opioids are amongst the most commonly prescribed drugs for low back pain 15, yet their use remains controversial 16. If non-pharmacological options such as bed rest, superficial heat, cryotherapy, exercise and physiotherapy are unsuccessful, pharmacological therapies are a second-line option 8, 12, 14. Management of CLBP, like other chronic pain conditions, aims to reduce pain and improve daily function. Chronic low back pain (CLBP) is one of the most prevalent types of chronic pain it is the leading global cause of disability, one of the common reasons for visits to physician’s office, correlates with work absence and is therefore associated with significant economic costs 8, 9, 10, 11, 12, 13. In general, the worldwide prevalence of chronic pain in developed nations is around 20% and can be grouped into seven etiologies: primary pain that is not explained by another pain condition, cancer pain, neuropathic pain, posttraumatic and postsurgical pain, musculoskeletal pain, visceral pain and headache and orofacial pain 3, 4, 5, 6, 7. While acute pain is generally nociceptive pain associated with somatosensory stimuli, chronic pain is thought to involve a shift from peripheral damage to more prominent central sensitization and central nervous system mechanisms 2. Healthcare providers involved in management of chronic non-cancer pain can include reduction or elimination of opioid use as part of treatment plan when contemplating 10 kHz SCS.Ĭhronic pain, defined as pain that remains beyond normal healing time, is a debilitating group of conditions and a prominent cause of disability worldwide 1.
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In conclusion, current analysis demonstrates the benefits of 10 kHz SCS therapy and offers an evidence-based, non-pharmaceutical alternative to opioid therapy and/or an adjunctive therapy to facilitate opioid dose reduction whilst delivering significant pain relief. The average dose of opioids in >90 MME group was significantly reduced by 46% following 10 kHz SCS therapy (p < 0.001), which was paralleled by significant pain relief (P < 0.001). Results showed that in the combined dataset, 39.3% of subjects were taking >90 MME dose of opioids at baseline compared to 23.0% at 12 months post-10 kHz SCS therapy (p = 0.007). Patient-reported back and leg pain using the visual analog scale (VAS) and opioid dose (milligrams morphine equivalent/day, MME/day) were compared at 12 months post-10 kHz SCS therapy to baseline. This study pooled data from two large prospective trials on 10 kHz spinal cord stimulation (10 kHz SCS) in subjects with chronic low back pain and/or leg pain and performed post hoc analysis on changes in opioid dosage 12 months post 10 kHz SCS treatment. While patient management aims to reduce pain and improve daily function, prescription of opioids remains widespread despite significant adverse effects.
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Chronic pain, including chronic low back and leg pain are prominent causes of disability worldwide.