1. 2018;21;E429-E434Comparison of the Efficacy of a Gabapentinoid with an Opioid Versus an Opioid Alone in Patients with Spinal Cord Stimulation
   Retrospective Review
   Jae Jun Lee, MD, Rak Min Choi, MD, Young Soo Kim, MD, Taehyung Yun, MD, Jong Ho Kim, MD, Sung Mi Hwang, MD, PhD, Youngsuk Kwon, MD, and Ji Su Jang, MD.

BACKGROUND: Combination therapy with a gabapentinoid and an opioid improves the quality of life (QOL) of patients with chronic pain. However, the role of combination therapy in patients with spinal cord stimulation (SCS) has not been evaluated.

OBJECTIVE: Our primary objective was to evaluate the clinical outcomes of combination therapy consisting of a gabapentinoid and an opioid in patients undergoing SCS.

STUDY DESIGN: Retrospective evaluation.

SETTING: Veterans Health Service Medical Center, Seoul, Korea.

METHODS: We retrospectively reviewed 100 military veteran patients who underwent SCS implantation. Forty-eight of 100 patients had been maintained on SCS for 2 years. Patients were divided into 2 groups by analgesic type: group A (opioid only, n = 20) and group B (opioid + gabapentinoids, n = 28). Pre-implantation information included the numeric rating scale (NRS) pain score, quality of life scale (QOLS) score, and oral morphine equivalents (OMEs). Post-implantation data were obtained at 1, 6, 12, and 24 months.

RESULTS: Group B had higher QOLS scores at 1, 6, 12, and 24 months than those of group A (P < 0.05). There were no statistically significant differences in the NRS pain score or OMEs at 1, 6, 12, or 24 months between the 2 groups.

LIMITATION: Retrospective design, relatively short follow up period (2 years).

CONCLUSION: This study indicated that the addition of a gabapentinoid to an opioid is superior to an opioid alone in terms of QOL in military veteran patients with SCS for 2 years. Combination therapy consisting of a gabapentinoid added to an opioid can be a good modality to improve QOL in patients with SCS.

KEY WORDS: Combination, drug therapy, gabapentin, multimodal analgesia, opioid, pain, pregabalin, spinal cord stimulation