A decade-long study suggests that for individuals with chronic neuropathic pain, successful treatment with spinal cord stimulation (SCS) is associated with a normal life expectancy, potentially negating the increased mortality risk that often accompanies the condition. Research from the University of Eastern Finland and Kuopio University Hospital indicates that patients who continuously used the therapy did not have higher mortality rates than a control group, a finding that positions the treatment as more than just a pain management tool. The study is the first to show that this form of neuromodulation may help avoid the excess deaths linked to severe, persistent pain.
Chronic pain is a widespread and debilitating condition, affecting as many as one in ten people in the case of neuropathic pain. Beyond the immediate suffering, the condition is independently associated with a higher risk of death. Furthermore, traditional pain management strategies, particularly long-term opioid therapy, introduce their own significant risks, including addiction and increased mortality. The new findings, published in the journal Neurosurgery, suggest that by effectively managing pain, spinal cord stimulation may offer a significant survival benefit, distinguishing it from pharmaceutical approaches that carry their own mortality risks.
A Large-Scale Observational Study
The Finnish research provides critical long-term data on the effects of spinal cord stimulation. Investigators followed a cohort of 330 patients who were treated for chronic neuropathic pain over a period of ten years. The study’s main goal was to compare mortality rates between patients who received sustained benefits from SCS and those who did not, as well as a control cohort representing the general population. The results revealed a stark divergence within the patient group.
The most significant finding was that patients who continued to use their SCS device throughout the follow-up period did not have a higher mortality rate than the control cohort. In stark contrast, a higher mortality rate was observed in two other groups: patients who underwent a trial stimulation but did not respond well enough to receive a permanent implant, and patients who had a device permanently implanted but later had the treatment discontinued. This suggests that the positive outcome is linked to the successful and continuous application of the therapy, rather than merely being a candidate for it.
The Mechanism of Neuromodulation
Spinal cord stimulation is a form of neuromodulation that has been used for decades to treat chronic pain that is resistant to other therapies. The technology is based on the “gate control theory” of pain, which posits that stimulating large sensory nerve fibers can inhibit or block the transmission of pain signals to the brain. By interrupting these signals, SCS can effectively reduce a person’s perception of pain.
How the Device Works
The system involves implanting a small electrode in the epidural space along the spinal canal. This electrode delivers precise, low-level electrical impulses directly to the sensory pathways of the spinal cord, specifically the dorsal column. The electrode is connected to an impulse generator, similar to a pacemaker, which is implanted under the skin. Before a patient receives a permanent implant, they typically undergo a trial period of about one week with an external device to determine if the therapy provides adequate pain relief. If the trial is successful, the permanent system is implanted.
Addressing Key Mortality Factors
The Finnish study highlights how effective pain management can potentially mitigate the downstream health risks associated with chronic pain. These risks often stem from the physiological stress of the pain itself or from complications related to common pain treatments, such as long-term opioid use.
Reducing Opioid Dependence
One of the most significant indirect benefits of spinal cord stimulation is its potential to reduce or stabilize the use of opioid medications. Research has consistently shown that many patients who receive SCS therapy are able to decrease their reliance on these powerful drugs. A large study involving over 5,400 patients found that individuals with a successful SCS implant had significantly lower opioid use one year after the procedure compared to their pre-implant levels. In contrast, patients who had their SCS systems removed saw their opioid consumption increase again over time. Given that long-term opioid use is a known contributor to increased mortality, this reduction is a critical pathway through which SCS may improve survival.
Interpretations and Future Implications
The findings from the Finnish cohort are the first to directly tie the continuous use of spinal cord stimulation to normal mortality rates in a chronic pain population. While the study did not find differences in the specific causes of death between the groups, the overall mortality data points to a powerful protective effect from successful pain management. The increased mortality among non-responders and those who discontinued therapy aligns with previous research on the excess mortality associated with chronic pain itself, reinforcing the idea that uncontrolled pain is a serious health risk.
This evidence supports the view that SCS is not just a symptomatic treatment but an intervention that can alter a patient’s long-term health trajectory. Experts suggest that patient outcomes could be improved if SCS were considered earlier in the treatment process, potentially before a patient develops a dependency on high-dose opioids. By providing an effective alternative, neuromodulation could help patients avoid the well-documented risks of addiction and overdose associated with long-term opioid therapy.
Established Role in Pain Management
While this study provides new insight into its effects on mortality, spinal cord stimulation is already a well-established tool for managing various types of chronic pain. It is most commonly indicated for conditions like failed back surgery syndrome, where pain persists after spinal surgery, and complex regional pain syndrome, a form of severe chronic pain that often affects an arm or a leg. Multiple studies have demonstrated its effectiveness in not only reducing pain but also improving quality of life and lowering the need for analgesic medications.
The technology continues to evolve, with advancements leading to more sophisticated and reliable devices. As research further illuminates its benefits, such as the potential to normalize life expectancy in those suffering from chronic pain, its role in the clinical landscape may expand, offering a durable and life-altering solution for patients who have run out of other options.
