The US government and other key stakeholders including professional medical bodies have amended recommendations in recent years to emphasize using no
opioids or the lowest effective dose of
opioids needed for treatment of
chronic pain. However, there remains an unmet need for
pain treatments that can both relieve the
pain of patients and reduce the doses of
opioids they require. The Center for Medicare and Medicaid Services (CMS) is currently considering such treatments through the SUPPORT ACT and has recently conferred with the Health and Human Services (HHS) Inter-agency
Pain Management Task Force to consider such
therapies. We reviewed literature evidence in PubMed on
pain relief and
opioid reduction following
spinal cord stimulation (SCS) treatment. SCS presents an effective non-pharmacologic
pain treatment modality that has been used for decades to reduce
chronic pain from
trauma or neuropathy and has been shown to either stabilize or reduce
opioid use in some patients with painful conditions. A more recently developed high-frequency SCS modality, 10 kHz SCS, has the advantage of being
paresthesia-independent. It has been shown to be associated with significant reductions in
opioid consumption after stimulation
therapy was initiated, and many patients even taking high doses of
opioids (> 90 mg
morphine equivalent dose per day) were able to reduce their
opioid intake to levels associated with less risk. The evidence shows that reduction of
opioids as early in the treatment process as possible is desirable to reduce patient risk and improve
pain relief from stimulation
therapy.