1. 2022;25;E739-E748Disability Pension Did Not Reduce Opioid Use Among Patients With Failed Back Surgery Syndrome Who Were Trialed and Implanted for Spinal Cord Stimulation
   Retrospective Study
   Hanna Kaijankoski, MD, Mette Nissen, MD, Janne Pesonen, MD, Tiina-Mari Ikaheimo, RN, Mikael von und zu Fraunberg, MD, PhD, Olavi Airaksinen, MD, PhD, and Jukka Huttunen, MD, PhD.

BACKGROUND: Spinal cord stimulation (SCS) is an effective treatment for failed back surgery syndrome (FBSS). In patients with FBSS, opioids have often been initiated, even before SCS is trialed.

OBJECTIVE: We studied the effect of retirement on opioid use in patients with chronic pain after failed back surgery.

STUDY DESIGN: A retrospective study design.

SETTING: The study was conducted at Kuopio University Hospital.

METHODS: The study group consisted of all 230 patients with SCS trialed or implanted for FBSS at Kuopio University Hospital Neurosurgery from January 1, 1996 through December 31, 2014. All purchases of prescribed opioids and their daily defined doses, as well as data on working ability, were obtained from the Social Insurance Institution. Patients were divided into 3 groups: SCS trial only, SCS implanted permanently, and SCS implanted but later explanted. We analyzed the differences in opioid use among these groups 2 years before and 2 years after the start of their disability pension (DP).

RESULTS: During the follow-up period, a total of 60 patients received a DP. One year before DP, the majority of patients used opioids (n = 43, 72%), and throughout the one-year follow-up after retirement, the number of users increased slightly (n = 46, 77%). In the permanently implanted SCS group, the number of strong opioid users decreased after retirement. Most patients used a moderate dose (0.1–10.5 morphine milligram equivalent/d). Retirement appeared to interrupt dose escalation in all groups, but doses increased further as the follow-up continued.

LIMITATIONS: No structured questionnaires were used in this study. Also, many underlying factors contributing to chronic pain were missing.

CONCLUSIONS: DP did not reduce the use of opioids in patients with FBSS. Opioid doses were lower and dose escalation less steep with continuous SCS therapy.

KEY WORDS: Failed back surgery syndrome, spinal cord stimulation, opioids, retirement, disability pension