Spinal cord stimulation and psychotropic medication use: Missing piece to the puzzle?

J Clin Neurosci. 2020 Nov:81:158-160. doi: 10.1016/j.jocn.2020.09.038. Epub 2020 Oct 12.

Abstract

Psychotropic medications have modulatory effects on spinal cord stimulator (SCS) therapy and may play an important role in determining treatment success in chronic pain management. However, it remains unknown how SCS affects psychotropic use and whether the medications affect outcome. We performed a retrospective study to determine the prevalence of psychotropic medication (i.e. anxiolytic, antidepressant, and anticonvulsant) use among new SCS patients immediately before implantation and characterized the dosage changes at 1-year. We also sought to understand whether pre-operative medication status affects outcome, defined as device explantation due to treatment failure. In an analysis of 45 patients, 31%, 51% and 71% were actively taking anxiolytics, antidepressants, and anticonvulsants, respectively, before surgery. In the majority of cases, daily dosages remained the same for all three classes of medication at 1-year. Patients who were on two or more classes of medications pre-operatively had significantly lower explantation rate compared to those with one or none (12% vs. 43%, p = 0.041) and had 5.25 times less likelihood of explanation in the future (OR 5.25, 95%CI 1.18-23.2, p = 0.029). Our study suggest that peri-operative multimodality medical treatment may enhance the therapeutic efficacy and durability of SCS in carefully selected chronic pain patients.

Keywords: Antidepressant; Antipsychotic; Anxiolytic; Chronic pain; Spinal cord stimulation.

MeSH terms

  • Adult
  • Antidepressive Agents
  • Chronic Pain
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Psychotropic Drugs / therapeutic use*
  • Retrospective Studies
  • Spinal Cord
  • Spinal Cord Stimulation / statistics & numerical data*
  • Treatment Outcome

Substances

  • Antidepressive Agents
  • Psychotropic Drugs