Are Spinal Cord Stimulators Ideal for Managing Chronic Pain?

When an employee experiences pain following a work injury, that pain eventually ceases once the cause of the pain has resolved or the injury has healed. But pain that persists for several months or beyond the normal healing period is considered chronic pain.¹ Chronic pain can range from mild to high-impact and have a profound effect on a person's physical, emotional, and social well-being.² Chronic pain can develop from a variety of causes, including but not limited to work injuries. According to the Bureau of Labor Statistics (BLS), the five leading causes of work injuries can contribute to chronic pain.³ The five leading causes of work injuries include:

• Overexertion and repetitive motion
• Slip and falls
• Contact with falling objects or equipment
• Vehicle accidents
• Machine entanglements

According to a 2021 study, one in five U.S. adults experiences chronic pain.⁴ Not only can chronic pain affect a person’s ability to work and function in everyday life; it can also be responsible for lost work productivity and increased health care costs.⁴ 

Helping employees manage chronic pain

There are several ways employers can help employees manage chronic pain associated with work or a work injury. One way is to provide employees access to rehabilitation services, especially following a work injury. Employers should also consider workplace accommodations that can help reduce the risk of exacerbating existing injuries. While an option like opioid therapy can be considered, it may come with great risks, such as opioid misuse or addiction.⁵ Plus, prescription pain medications may not address the underlying causes of chronic pain and, therefore, offer little benefit to functional restoration or the healing process in general.

Spinal cord stimulation

Spinal cord stimulators have been used as treatment alternatives to other pain management options such as opioid therapy. Spinal cord stimulators were introduced in the 1960s, with the first implantation occurring in 1967.⁶  The medical device is surgically implanted during a minimally invasive procedure and uses low electrical impulses to block pain signals before they reach the brain.⁷

It’s worth noting that spinal cord stimulators should be considered only after other pain management treatment options have been explored. In other words, it’s not recommended as a first-line treatment option. What is recommended, however, is that workers’ compensation payors consult an occupational medicine professional to determine if spinal cord stimulation is the appropriate option based on an employee’s condition.

Determining medical necessity

While spinal cord stimulation can be an effective treatment option for some employees with chronic pain, it can be costly. Workers’ compensation payors can enlist a peer review service provider to help determine if the treatment method is medically necessary.

Some reasons why spinal cord stimulators may not be necessary or cost-effective include:

• Lack of Evidence-based Benefits: Although spinal cord stimulators have been used for decades, there is still a lack of robust evidence that supports their effectiveness in treating chronic pain. Some studies have shown that it may be effective for certain types of pain, while others have not found significant benefits.
• High Costs: Spinal cord stimulator implantation can involve several visits to medical professionals for various services including consultations, imaging, and the implantation procedure itself. Additionally, the device needs to be maintained and may require future replacements, which can add to the overall cost.
• Potential Risks and Complications: Like all medical procedures, spinal cord stimulator implantation carries risks and potential complications, including infection, bleeding, spinal cord damage, and device malfunction.
• Alternative Treatment Options: Depending on the type and cause of chronic pain, there may be alternative treatment options that are less invasive, less costly, and more effective for some patients. These may include physical therapy or less invasive procedures such as nerve blocks.
• Lack of Patient Response: Even if the procedure is deemed necessary and cost-effective, some patients may not respond to spinal cord stimulation. It can take several weeks or even months to determine whether the device is effective for the patient. And in some cases, the device may need to be removed if it does not provide significant pain relief.

Concentra peer review services

For businesses that prefer peer reviews performed by physicians with expertise in pain management treatment options such as spinal cord stimulator surgery, Concentra® offers Medical ReviewStream™. Our clinical team can carefully evaluate each case and recommend appropriate treatment options. Our peer review services can help avoid medically unnecessary spinal cord stimulator surgeries, ultimately lowering health care costs for insurance companies.

Concentra understands the importance of providing high-quality health care while also managing costs. Our peer review services can help strike this balance by ensuring employees receive the care best suited to improve their health outcomes while also helping businesses avoid unnecessary expenses.

Consult medical experts for pain management solutions

While spinal cord stimulators may provide relief for some employees living with chronic pain, this treatment option could have drawbacks. The cost and invasiveness of spinal cord stimulator surgery, potential for complications, and lack of long-term research can make it a less-than-ideal option in some cases. It's important to weigh the potential benefits and risks of any pain management treatment option and partner with an occupational medicine expert to authorize treatment that meets the employee’s needs. For more information about Concentra’s medical review services, visit medicalreviewstream.com.

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Sources:

1. National Institutes of Health. Chronic Pain: What You Need to Know. (2023). National Center for Complementary and Integrative Health.
2. American Psychiatric Association. (2020, November 13). Psychiatry.org. Chronic Pain and Mental Health Often Interconnected.
3. U.S. Bureau of Labor Statistics. Injuries, Illnesses, and Fatalities.
4. Yong, R. J., Mullins, P. M., and Bhattacharyya, N. (2021). The prevalence of chronic pain among adults in the United States. Pain.
5. Centers for Disease Control and Prevention. (2020, December 16). Manage Pain with Your Doctor.
6. North, R. B., and Wetzel, F. T. (2002). Spinal cord stimulation for chronic pain of spinal origin: a valuable long-term solution. Spine, 27 (22), 2584–2591.
7. Dydyk, A. M., and Tadi, P. (2022). Spinal cord stimulator implant. PubMed; StatPearls Publishing.