(394) Use of spinal cord stimulators for veterans in the VHA MSD cohort

Abstract

Spinal cord stimulator (SCS) implantation is a commonly used pain management option to treat severe pain conditions, including some musculoskeletal disorders (MSDs). Few large studies have examined the demographic and clinical characteristics of patients receiving SCSs or the characteristics of facilities that perform SCS implantation. There are no studies addressing these issues in the Veterans Healthcare Administration (VHA). We used the data from the VHA funded MSD cohort study (MSD; n=5.1 million) to identify veterans who underwent SCS implantation from 2000-2014. Descriptive statistics were used to characterize veterans who did/did not receive a SCS. A total of 2,477 temporary and permanent SCS implantations were identified. Between 2000 and 2010, implantations increased steadily; however, that trend reversed in 2011. Compared to those who did not receive SCSs, those who did were more likely to be under age 45 (37.7%), male (90.3%), and White (82.2%). Their pain diagnoses were consistent with those generally indicated for SCSs (e.g. postlaminectomy syndrome-lumbar region, thoracic or lumbosacral neuritis or radiculitis, and lumbago). Veterans receiving SCSs had higher pain intensity ratings (Mean=5.28) and were more likely to receive opioid therapy; specifically 89.4% of the veterans who received SCSs received opioids in the year prior to implant and 64.5% had received long-term opioid therapy. Veterans receiving SCSs had lower rates of comorbid medical conditions and alcohol use disorder, but higher rates of mood and anxiety disorders. A majority of SCSs were implanted by neurosurgery, anesthesiology, and pain medicine, and most implantations were at large tertiary facilities. Implantations also frequently occurred at the facility where the veteran received his/her MSD diagnosis (73.31%). These findings suggest that VHA providers are using SCSs to treat patients experiencing treatment-refractory pain consistent with common indications for SCSs. The study also suggests that demographic, clinical, and facility characteristics influence veterans’ likelihood of receiving SCSs.