Chief of Spine Division Duke University Durham, North Carolina, United States
Disclosure(s):
Christopher I. Shaffrey, MD, FAANS: Depuy: Research Grant (Ongoing); Medtronic: Consultant (Ongoing), Research Grant (Ongoing), Royalty Recipient (Ongoing); Neurosurgery RRC: Research Grant (Ongoing); NuVasive: Advisor (Ongoing), Consultant (Ongoing), Royalty Recipient (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing); Proprio: Consultant (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing)
Introduction: Pain impact is an important construct that correlates with both functional and economic outcomes. High-impact chronic low back pain (CLBP) has been defined by the US Department of Health and Human Services (HHS) severe, persistent and preventing activities of daily living. These patients are more likely to be frequent users of high-cost healthcare resources. Therapies that deliver durable benefit in both pain and dysfunction reduce downstream direct and indirect healthcare costs. Restorative neurostimulation is an effective therapy for CLPB patients who have failed conservative management and have few viable therapeutic options remaining.
Methods: A cohort of 146 patients with complete data were included in this analysis from the patients completing 2 year follow-up of the ReActiv8-B study1 Patients were stratified into three impact categories (high, medium, and low impact CLBP) using the definition proposed by the HHS. Criteria were based on pain duration and severity, and impact to work, self-care and social activities. Indirect cost-drivers were also collected through questionnaires evaluating work impact.
Results: Following two years of therapy 124 (84.9%) of all patients were classified as low impact pain class. Of the 103 patients with high impact pain at baseline, 85 (82.5%) reported low impact pain, 5 (4.8%) transitioned to a moderate pain class and only 13 (12.6%) remained unchanged. At baseline, 9/146 (6.2%) of patients reported no work problems due to low back pain. After 2 years this improved to 73/146 (50%). The proportion of patients rating their “ability to do your work at its best” as a 9 or 10 was 87/146 (60%) at 2 years compared to just 21/146 (14%) at baseline.
Conclusion : Restorative neurostimulation is one therapeutic option that should reduce healthcare consumption over the long term in line with meaningful and durable symptom relief and transition from the high impact pain category.
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