A new study suggests that spinal cord stimulation may help to reduce the increased risk of death often associated with chronic pain. The research, which followed 330 patients over a decade, found that those who successfully used the therapy had mortality rates comparable to the general population, a stark contrast to patients who did not respond to or discontinued the treatment. This finding is particularly significant given that chronic pain itself is an independent risk factor for premature death, and common pain management strategies like long-term opioid use are also linked to higher mortality.
The study, conducted by researchers at the University of Eastern Finland and Kuopio University Hospital and published in the journal Neurosurgery, offers a new perspective on managing chronic neuropathic pain, a debilitating condition affecting as much as 10% of the population. Spinal cord stimulation, a form of neuromodulation, has been used for decades to treat chronic pain, but this is the first study to suggest a link between its successful long-term use and a reduction in the excess mortality associated with the condition. The findings could have significant implications for how clinicians and patients approach the treatment of chronic pain, potentially offering a life-extending alternative to long-term opioid therapy.
Understanding Spinal Cord Stimulation
Spinal cord stimulation is a medical technology designed to manage chronic pain by altering pain signals before they reach the brain. The therapy is based on the gate control theory of pain, which posits that non-painful stimuli can “close the gates” to painful sensations. A spinal cord stimulator system consists of three main components: a small, pacemaker-like device called an implantable pulse generator, thin wires called leads, and a handheld remote control.
The leads are surgically placed in the epidural space, the area surrounding the spinal cord. These leads are connected to the implantable pulse generator, which is typically implanted under the skin in the abdomen, flank, or gluteal region. The generator sends mild electrical impulses through the leads to the spinal cord, which disrupt the pain signals traveling to the brain and replace them with a more pleasant sensation, often described as a mild tingling. Newer technologies have even developed “paresthesia-free” stimulation, which does not produce this tingling sensation. Patients can use a remote control to turn the device on and off, adjust the intensity of the stimulation, and switch between different programs.
The Implantation Process
Before a permanent device is implanted, patients typically undergo a trial period of about a week. In this trial, temporary leads are placed through a needle into the epidural space and connected to an external generator. This allows the patient to experience the therapy and determine if it provides adequate pain relief. If the trial is successful, the patient can then proceed with the permanent implantation of the device. The implantation is a surgical procedure, and like any surgery, it carries some risks, including infection, lead movement, and pain at the implant site. However, for many patients, the benefits of spinal cord stimulation in terms of pain relief and improved quality of life can be substantial.
The Finnish Study: A Closer Look
The recent study from the University of Eastern Finland and Kuopio University Hospital provides compelling evidence for the long-term benefits of spinal cord stimulation. The researchers followed a cohort of 330 patients with chronic neuropathic pain for a period of ten years. The study’s primary objective was to investigate the association between spinal cord stimulation and mortality in this patient population.
Key Findings
The study’s most significant finding was that patients who continued to use spinal cord stimulation throughout the ten-year follow-up period had a mortality rate that was not significantly different from that of a control cohort from the general population. In contrast, patients who did not respond to the initial trial of spinal cord stimulation, as well as those who had the device removed and discontinued the therapy during the follow-up period, had a higher mortality rate than the control group. The causes of death in these groups were not different from the control cohort, suggesting that the increased mortality was not due to a specific complication of the therapy but rather a reflection of the underlying health risks associated with untreated or ineffectively managed chronic pain.
The Connection Between Chronic Pain and Mortality
Chronic pain is not just a symptom; it is a complex condition that can have far-reaching effects on a person’s physical and mental health. The constant presence of pain can lead to a host of other health problems, including depression, anxiety, sleep disturbances, and reduced mobility. These factors, in turn, can contribute to an increased risk of mortality. Moreover, some of the most common treatments for chronic pain, particularly long-term opioid therapy, come with their own set of risks, including addiction, overdose, and an increased risk of death.
The Finnish study’s findings are important because they suggest that effective pain management can mitigate the excess mortality associated with chronic pain. By providing a non-opioid alternative for pain relief, spinal cord stimulation may help to break the cycle of chronic pain and its associated health risks. This is particularly relevant in the context of the ongoing opioid crisis, as healthcare providers and patients are actively seeking safer and more effective ways to manage chronic pain.
Implications for Pain Management
The results of this study could have a significant impact on the future of chronic pain management. By demonstrating a potential survival benefit associated with spinal cord stimulation, the research provides a strong rationale for considering this therapy earlier in the treatment of chronic neuropathic pain. Currently, spinal cord stimulation is often considered a last resort for patients who have not responded to other treatments. However, this study suggests that it may be beneficial to offer this therapy to a wider range of patients, particularly those who are at high risk for the adverse effects of long-term opioid use.
As Neurosurgeon Antti J. Luikku, a member of the research team, stated, “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.” This highlights the potential for spinal cord stimulation to not only improve the quality of life for patients with chronic pain but also to extend their lives.
A Non-Opioid Alternative with a Favorable Safety Profile
Spinal cord stimulation is a well-established therapy that has been used to treat chronic pain for over 50 years. Over the decades, the technology has evolved significantly, with smaller, more sophisticated devices and a wider range of stimulation options. The therapy has been shown to be safe and effective for a variety of chronic pain conditions, including failed back surgery syndrome, complex regional pain syndrome, and chronic peripheral neuropathies.
While spinal cord stimulation is not without risks, the potential complications are generally manageable. The most common risks include infection, lead movement, and pain at the implant site. However, the therapy does not carry the same risks of addiction and overdose associated with long-term opioid use. Furthermore, studies have shown that spinal cord stimulation can lead to a reduction in opioid consumption, further enhancing its safety profile. For patients with chronic pain, spinal cord stimulation represents a viable and potentially life-saving alternative to long-term opioid therapy, offering the promise of not only pain relief but also a longer, healthier life.