(289) - Spinal cord stimulators at walter reed national military medical center: Opioid prescription practices at 6-month follow-up

Abstract

Research on spinal cord stimulators (SCS) suggests that they may be effective devices for non-pharmacological pain management. However, there is minimal research examining opioid prescribing practices and SCS use in the Military Health System (MHS). The objective of this quality improvement project was to determine whether opioid use varied between patients with a negative SCS trial and those with a positive trial and subsequent permanent implant. The Walter Reed National Military Medical Center (WRNMMC) SCS Cohort includes patients (active duty, veterans, and dependents) who completed a SCS trial and received a permanent implant. This project compared a sub-sample of the Cohort: patients for whom we had 6-month follow-up data with a negative trial (N = 27) and those with a positive trial and permanent implant (N = 70). The majority of patients were male, active duty, with pain from noncombat-related injuries. The mean age was about 46 years. No statistically significant differences between demographic characteristics were found between patients who only had trials and those who went on to permanent implant. T-test suggests that patients with a negative trial had significantly higher Morphine Equivalent (MEQ) mean at baseline than those who underwent the permanent implant. RANOVA results suggest that patients who underwent the trial only did not experience a significant reduction in MEQ between baseline, 3-month, and/or 6-month follow-up; whereas patients who underwent a permanent implant had a significant reduction in MEQ from baseline to 6-months post implant. Findings suggest that patients with a negative SCS trial had higher MEQ at baseline and were less likely to experience a reduction in MEQ at 6-months than those with a positive trial and permanent implant. Findings may suggest that the MEQ dosage at baseline is predictive of eligibility for permanent implantation and that SCS implants may help reduce MEQ dosages.