Sex-specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic pain
Abstract Introduction Spinal cord stimulation (SCS), an FDA-approved therapy for chronic pain, uses paresthesia (low frequency SCS (LF-SCS)) or paresthesia-free (such as high-frequency SCS (HF-SCS)) systems, providing analgesia through partially-elucidated mechanisms, with recent studies indicating...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | Bioelectronic Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42234-022-00090-2 |
| _version_ | 1828839903805308928 |
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| author | Rosalynn R. Z. Conic Jacob Caylor Christina L. Cui Zabrina Reyes Eric Nelson Sopyda Yin Imanuel Lerman |
| author_facet | Rosalynn R. Z. Conic Jacob Caylor Christina L. Cui Zabrina Reyes Eric Nelson Sopyda Yin Imanuel Lerman |
| author_sort | Rosalynn R. Z. Conic |
| collection | DOAJ |
| description | Abstract Introduction Spinal cord stimulation (SCS), an FDA-approved therapy for chronic pain, uses paresthesia (low frequency SCS (LF-SCS)) or paresthesia-free (such as high-frequency SCS (HF-SCS)) systems, providing analgesia through partially-elucidated mechanisms, with recent studies indicating a sexual dimorphism in pain pathogenesis (Bretherton et al., Neuromodulation, 2021; Paller et al., Pain Med 10:289–299, 2009; Slyer et al., Neuromodulation, 2019; Van Buyten et al., Neuromodulation 20:642–649, 2017; Mekhail et al., Pain Pract, 2021). We aim to evaluate SCS therapy sex effects based on paradigm, utilizing visual analog scores (VAS), perceived pain reduction (PPR), and opioid use. Methods A retrospective cohort study of SCS patients implanted between 2004 and 2020 (n = 237) was conducted. Descriptive statistics and linear mixed methods analyses were used. Results HF-SCS (10 kHz) was implanted in 94 patients (40 females, 54 males), and LF-SCS in 143 (70 females, 73 males). At 3 months and 6 months, HF-SCS (p < 0.001) and LF-SCS (p < 0.005) had lower VAS scores compared to baseline (p < 0.005), with no differences across groups. PPR improved in both post-implantation (p < 0.006) and at 3 months (p < 0.004 respectively), compared to baseline persisting to 6 (p < 0.003) and 12 months (p < 0.01) for HF-SCS, with significantly better PPR for HF-SCS at 3 (p < 0.008) and 6 (p < 0.001) months compared to LF-SCS. There were no differences in opioid use from baseline for either modality; however LF-SCS patients used more opioids at every time point (p < 0.05) compared to HF-SCS. VAS was improved for all modalities in both sexes at 3 months (p = 0.001), which persisted to 6 months (p < 0.05) for HF-SCS males and females, and LF-SCS females. Female HF-SCS had improved PPR at 3 (p = 0.016) and 6 (p = 0.022) months compared to baseline, and at 6 (p = 0.004) months compared to LF-SCS. Male HF-SCS and LF-SCS had improved PPR post-implantation (p < 0.05) and at 3 months (p < 0.05), with HF-SCS having greater benefit at 3 (p < 0.05) and 6 (p < 0.05) months. LF-SCS males but not females used less opioids at 6 months (p = 0.017) compared to baseline; however this effect did not persist. On linear mixed model analyses, including age, sex and stimulator type, VAS decreased with age, at each timepoint, and had a trend towards increasing with female sex, while PPR increased at 3 and 6 months and lastly HF-SCS was associated with decreased opioid use. Discussion PPR at 3 and 6 months improved to a greater extent in HF-SCS. HF-SCS females had improved PPR at 3 and 6 months, and only LF-SCS males used less opioids at 6 months, potentially indicating sex-based pathway. Future studies should further elucidate differences in sex-based pathways and identify optimal SCS opioid-sparing paradigms for chronic pain patients. |
| first_indexed | 2024-12-12T19:32:36Z |
| format | Article |
| id | doaj.art-11ffd6c2bbb14ce5bc0234cbf34b044b |
| institution | Directory Open Access Journal |
| issn | 2332-8886 |
| language | English |
| last_indexed | 2024-12-12T19:32:36Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Bioelectronic Medicine |
| spelling | doaj.art-11ffd6c2bbb14ce5bc0234cbf34b044b2022-12-22T00:14:23ZengBMCBioelectronic Medicine2332-88862022-04-018111410.1186/s42234-022-00090-2Sex-specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic painRosalynn R. Z. Conic0Jacob Caylor1Christina L. Cui2Zabrina Reyes3Eric Nelson4Sopyda Yin5Imanuel Lerman6Department of Family Medicine and Public Health, University of California, San DiegoDepartment of Anesthesiology, Center for Pain Medicine, University of California San Diego School of MedicineDivision of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical CenterSchool of Medicine, University of California, San DiegoCollege of Osteopathic Medicine of the Pacific Western University of Health SciencesDepartment of Anesthesiology, Center for Pain Medicine, University of California San Diego School of MedicineDepartment of Anesthesiology, Center for Pain Medicine, University of California San Diego School of MedicineAbstract Introduction Spinal cord stimulation (SCS), an FDA-approved therapy for chronic pain, uses paresthesia (low frequency SCS (LF-SCS)) or paresthesia-free (such as high-frequency SCS (HF-SCS)) systems, providing analgesia through partially-elucidated mechanisms, with recent studies indicating a sexual dimorphism in pain pathogenesis (Bretherton et al., Neuromodulation, 2021; Paller et al., Pain Med 10:289–299, 2009; Slyer et al., Neuromodulation, 2019; Van Buyten et al., Neuromodulation 20:642–649, 2017; Mekhail et al., Pain Pract, 2021). We aim to evaluate SCS therapy sex effects based on paradigm, utilizing visual analog scores (VAS), perceived pain reduction (PPR), and opioid use. Methods A retrospective cohort study of SCS patients implanted between 2004 and 2020 (n = 237) was conducted. Descriptive statistics and linear mixed methods analyses were used. Results HF-SCS (10 kHz) was implanted in 94 patients (40 females, 54 males), and LF-SCS in 143 (70 females, 73 males). At 3 months and 6 months, HF-SCS (p < 0.001) and LF-SCS (p < 0.005) had lower VAS scores compared to baseline (p < 0.005), with no differences across groups. PPR improved in both post-implantation (p < 0.006) and at 3 months (p < 0.004 respectively), compared to baseline persisting to 6 (p < 0.003) and 12 months (p < 0.01) for HF-SCS, with significantly better PPR for HF-SCS at 3 (p < 0.008) and 6 (p < 0.001) months compared to LF-SCS. There were no differences in opioid use from baseline for either modality; however LF-SCS patients used more opioids at every time point (p < 0.05) compared to HF-SCS. VAS was improved for all modalities in both sexes at 3 months (p = 0.001), which persisted to 6 months (p < 0.05) for HF-SCS males and females, and LF-SCS females. Female HF-SCS had improved PPR at 3 (p = 0.016) and 6 (p = 0.022) months compared to baseline, and at 6 (p = 0.004) months compared to LF-SCS. Male HF-SCS and LF-SCS had improved PPR post-implantation (p < 0.05) and at 3 months (p < 0.05), with HF-SCS having greater benefit at 3 (p < 0.05) and 6 (p < 0.05) months. LF-SCS males but not females used less opioids at 6 months (p = 0.017) compared to baseline; however this effect did not persist. On linear mixed model analyses, including age, sex and stimulator type, VAS decreased with age, at each timepoint, and had a trend towards increasing with female sex, while PPR increased at 3 and 6 months and lastly HF-SCS was associated with decreased opioid use. Discussion PPR at 3 and 6 months improved to a greater extent in HF-SCS. HF-SCS females had improved PPR at 3 and 6 months, and only LF-SCS males used less opioids at 6 months, potentially indicating sex-based pathway. Future studies should further elucidate differences in sex-based pathways and identify optimal SCS opioid-sparing paradigms for chronic pain patients.https://doi.org/10.1186/s42234-022-00090-2Spinal cord stimulatorOutcomesHF-SCSLF-SCSVASOpioid |
| spellingShingle | Rosalynn R. Z. Conic Jacob Caylor Christina L. Cui Zabrina Reyes Eric Nelson Sopyda Yin Imanuel Lerman Sex-specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic pain Bioelectronic Medicine Spinal cord stimulator Outcomes HF-SCS LF-SCS VAS Opioid |
| title | Sex-specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic pain |
| title_full | Sex-specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic pain |
| title_fullStr | Sex-specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic pain |
| title_full_unstemmed | Sex-specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic pain |
| title_short | Sex-specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic pain |
| title_sort | sex specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic pain |
| topic | Spinal cord stimulator Outcomes HF-SCS LF-SCS VAS Opioid |
| url | https://doi.org/10.1186/s42234-022-00090-2 |
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