Effect of Restorative Neurostimulation on Major Drivers of Chronic Low Back Pain Economic Impact
Christopher Gilligan1 and Christopher Shaffrey2
1Brigham and Women's Healthcare, Harvard Medical School, Boston, MA, USA ; 2Duke University Spine Center, Durham, NC, USA
Introduction
•Pain impact is an important construct, especially in chronic low back pain (CLBP), that correlates with both functional and economic outcomes
•High impact pain definition1 is:
̶pain present on most days for ≥ 6 months
̶associated with substantial restriction of work, social, and self-care activity
•Patients with high impact CLBP are more likely to be:
̶frequent users of high-cost healthcare resources
̶report substantially higher average pain intensities
̶describe higher pain-related interference with life and work-related activities.2
•Therapies delivering durable pain and functional benefits reduce downstream direct and indirect healthcare costs
•Restorative neurostimulation is applicable to patients with high impact CLBP who have failed conservative management and have few viable therapeutic options remaining3
Aim: Establish whether long-term restorative neurostimulation clinical benefits also result in improvements in economic impact of major drivers of CLBP
Methods
•N=146 patients with neurostimulation with complete 2-year data
•Patients stratified to high, medium, and low impact CLBP
•Indirect drivers (i.e., work performance) collected by questionnaires
Results
Pain Impact after 2-year follow-up
•N = 124 (84.9%) of all patients were in low impact pain class
•85/103 patients (82.5%) transitioned from high to low impact pain
•5/103 (4.8%) transitioned from high to moderate pain
•13/103 (12.6%) remained unchanged
Presenteeism after 2-year follow-up
•Work performance assessed as “ability to do your work at its best” on 10-point numerical rating scale
•Baseline mean score (6.0±0.2) improved to 7.8±0.2, 8.1±0.2 and 8.3±0.2 at 6 months, 1, and 2 years, respectively.
•Proportion of patients rating their work ability as 9 or10 was 87/146 (60%) after 2 years vs. 21/146 (14%) at baseline
Work Problems after 2-year follow-up
•Baseline = 137/146 (93.8%) of patients reported work problems due to CLBP
•1-year follow-up = improved to 67/146 (45.9%) working without problems
•2-year follow-up = 50.1% working without problems
After two years of restorative neurostimulation:
•High impact CLBP transitioned to much lower impact
•Work ability improved from 6% to 50.1%
•Presenteeism improved from 14% to 60%
•May help reduce high impact pain healthcare utilization
