Excess mortality associated with chronic pain can be avoided through spinal cord stimulation

Treating chronic neuropathic pain with spinal cord stimulation may help prevent excess mortality associated with chronic pain, a new study from the University of Eastern Finland and Kuopio University Hospital shows. The findings were published in Neurosurgery.

Chronic neuropathic pain is a difficult-to-treat condition affecting up to one in ten people. Most individuals living with chronic pain will have a good and durable response to treatment in the case of, e.g., neuropathic pain medications, or pain-targeting physical and occupational therapy. However, some patients end up on long-term opioid therapy, which is known to be addictive and associated with increased overall mortality. Moreover, chronic pain itself has also been shown to be independently associated with elevated mortality rates.

Spinal cord stimulation is a neuromodulation therapy for chronic pain, in which an electrode placed in the spinal canal delivers electrical impulses to the sensory tracts of the spinal cord, specifically the dorsal column. The device is powered by, and programmed via, an impulse generator implanted under the skin. Before permanent implantation, patients undergo a one-week trial period to assess their response to pain alleviation.

The study found that patients who did not respond to spinal cord stimulation had a higher mortality rate than the control cohort. A similar increase in mortality was observed among patients whose treatment was discontinued during the follow-up period. However, there were no differences in either group's causes of death, compared to the control cohort. These findings are consistent with previous research on excess mortality associated with chronic pain.

However, the study is the first in the world to show that patients who continued spinal cord stimulation throughout the follow-up period did not differ from the control cohort in terms of mortality.

This finding suggests that excess mortality associated with chronic pain can be avoided through successful pain management. As a pain management strategy, spinal cord stimulation differs significantly from long-term opioid therapy, which is addictive and increases mortality."

Antti J. Luikku, MD, PhD, neurosurgeon, member of the research team

The study included 330 patients with chronic neuropathic pain, who were followed up for a period of ten years.