Advertisement

Men and Women Respond Equally Well to Spinal Cord and Dorsal Root Ganglion Stimulation

Published:June 13, 2022DOI:https://doi.org/10.1111/ner.13484

      Abstract

      Objectives

      The influence of gender on outcomes in individuals undergoing treatment for chronic pain is unclear. This retrospective, single-site study explored the impact of gender on pain, quality of life (QoL), revisions, and explants in patients with failed back surgery syndrome or visceral pain, who received a fully implanted 10 kHz spinal cord stimulation (SCS), burst SCS, or dorsal root ganglion (DRG) stimulation system.

      Materials and Methods

      The following data were collected from paper and electronic records: gender, age, chronic pain diagnosis, system, baseline and follow-up scores (average pain [visual analog scale, VAS], worst pain [VAS], QoL [EQ-5D-3L]), revisions, and explants. Data were statistically analyzed by one-way ANCOVAs controlling for age, chi-square tests of independence, and logistic regression.

      Results

      The final sample comprised 387 patients (176 males and 211 females). Males were significantly older compared to females (mean difference: 2.33 years, p = 0.044). Controlling for age, baseline average pain was significantly lower in males than females (mean difference: −0.32, p = 0.049). Males and females responded equally well to 10 kHz SCS and burst SCS as well as DRG stimulation. A greater percentage of males (5%) than females (1%) had revisions due to lead fractures. Additionally, more females (13%) than males (6%) had an explant due to insufficient pain relief. Female gender and older age were associated with greater likelihood of having an explant compared to male gender and younger age.

      Conclusion

      Gender may play an influential role in pain severity at baseline but have little effect at follow-up. To help identify which patients may undergo a revision or explant, gender and age could be important factors and should be further scrutinized. Even though men and women responded equally well to SCS and DRG stimulation, more men had a revision due to lead fractures, and more women were explanted due to insufficient pain relief.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fillingim R.B.
        • King C.D.
        • Ribeiro-Dasilva M.C.
        • Rahim-Williams B.
        • Riley J.L.
        Sex, gender, and pain: a review of recent clinical and experimental findings.
        J Pain. 2009; 10: 447-485
        • Racine M.
        • Tousignant-Laflamme Y.
        • Kloda L.A.
        • Dion D.
        • Dupuis G.
        • Choinière M.
        A systematic literature review of 10 years of research on sex/gender and experimental pain perception – Part 1: are there really differences between women and men?.
        Pain. 2012; 153: 602-618
        • Meucci R.D.
        • Fassa A.G.
        • Faria N.M.X.
        Prevalence of chronic low back pain: systematic review.
        Rev Saude Publica. 2015; 49: 1-10
        • Racine M.
        • Castarlenas E.
        • de la Vega R.
        • et al.
        Sex differences in psychological response to pain in patients with fibromyalgia syndrome.
        Clin J Pain. 2015; 31: 425-432
        • Turk D.C.
        • Okifuji A.
        Does sex make a difference in the prescription of treatments and the adaptation to chronic pain by cancer and non-cancer patients?.
        Pain. 1999; 82: 139-148
        • Fillingim R.B.
        • Doleys D.M.
        • Edwards R.R.
        • Lowery D.
        Clinical characteristics of chronic back pain as a function of gender and oral opioid use.
        Spine (Phila Pa 1976). 2003; 28: 143-150
        • Barnabe C.
        • Bessette L.
        • Flanagan C.
        • et al.
        Sex differences in pain scores and localization in inflammatory arthritis: a systematic review and metaanalysis.
        J Rheumatol. 2012; 39: 1221-1230
        • Tang Y.
        • Yang W.
        • Wang Y.-L.
        • Lin L.
        Sex differences in the symptoms and psychological factors that influence quality of life in patients with irritable bowel syndrome.
        Eur J Gastroenterol Hepatol. 2012; 24: 702-707
        • Keefe F.J.
        • Lefebvre J.C.
        • Egert J.R.
        • Affleck G.
        • Sullivan M.J.
        • Caldwell D.S.
        The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing.
        Pain. 2000; 87: 325-334
        • Sullivan M.J.L.
        • Tripp D.A.
        • Santor D.
        Gender differences in pain and pain behavior: the role of catastrophizing.
        Cognit Ther Res. 2000; 24: 121-134
        • Duan-Porter W.
        • Goldstein K.M.
        • McDuffie J.R.
        • et al.
        Reporting of sex effects by systematic reviews on interventions for depression, diabetes, and chronic pain.
        Ann Intern Med. 2016; 165: 184-193
        • Niesters M.
        • Dahan A.
        • Kest B.
        • et al.
        Do sex differences exist in opioid analgesia? A systematic review and meta-analysis of human experimental and clinical studies.
        Pain. 2010; 151: 61-68
        • Paller C.J.
        • Campbell C.M.
        • Edwards R.R.
        • Dobs A.S.
        Sex-based differences in pain perception and treatment.
        Pain Med. 2009; 10: 289-299
        • Keogh E.
        • Herdenfeldt M.
        Gender, coping and the perception of pain.
        Pain. 2002; 97: 195-201
        • Pieh C.
        • Altmeppen J.
        • Neumeier S.
        • Loew T.
        • Angerer M.
        • Lahmann C.
        Gender differences in outcomes of a multimodal pain management program.
        Pain. 2012; 153: 197-202
        • Keogh E.
        • McCracken L.M.
        • Eccleston C.
        Do men and women differ in their response to interdisciplinary chronic pain management?.
        Pain. 2005; 114: 37-46
        • Hirsh A.T.
        • George S.Z.
        • Robinson M.E.
        Pain assessment and treatment disparities: a virtual human technology investigation.
        Pain. 2009; 143: 106-113
        • LA Wandner S.
        • Alqudah A.F.
        • Craggs J.G.
        • Scipio C.D.
        • Hirsh A.T.
        • et al.
        Virtual human technology: patient demographics and healthcare training factors in pain observation and treatment recommendations.
        J Pain Res. 2010; 3: 241-247
        • Stutts L.A.
        • Hirsh A.T.
        • George S.Z.
        • Robinson M.E.
        Investigating patient characteristics on pain assessment using virtual human technology.
        Eur J Pain. 2010; 14: 1040-1045
        • Hirsh A.T.
        • Alqudah A.F.
        • Stutts L.A.
        • Robinson M.E.
        Virtual human technology: capturing sex, race, and age influences in individual pain decision policies.
        Pain. 2008; 140: 231-238
        • Mogil J.S.
        • Bailey A.L.
        Sex and gender differences in pain and analgesia.
        Prog Brain Res. 2010; 186: 140-157
        • Sorge R.E.
        • Totsch S.K.
        Sex differences in pain.
        J Neurosci Res. 2017; 95: 1271-1281
        • Kumar K.
        • Hunter G.
        • Demeria D.
        Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and present status, a 22-year experience.
        Neurosurgery. 2006; 58: 481-496
        • van Buyten J-P
        • Wille F.
        • Smet I.
        • et al.
        Therapy-related explants after spinal cord stimulation: results of an international retrospective chart review study.
        Neuromodulation. 2017; 20: 642-649
        • Slyer J.
        • Scott S.
        • Sheldon B.
        • Hancu M.
        • Bridger C.
        • Pilitsis J.G.
        Less pain relief, more depression, and female sex correlate with spinal cord stimulation explants.
        Neuromodulation. 2020; 23: 673-679
        • de Jaeger M.
        • Goudman L.
        • Eldabe S.
        • van Dongen R.
        • de Smedt A.
        • Moens M.
        The association between pain intensity and disability in patients with failed back surgery syndrome, treated with spinal cord stimulation.
        Disabil Rehabil. 2019; 24: 1-7
        • Wiesenfeld-Hallin Z.
        Sex differences in pain perception.
        Gend Med. 2005; 2: 137-145
        • Berkley K.J.
        Sex differences in pain.
        Behav Brain Sci. 1997; 20: 371-380
        • Stauss T.
        • El Majdoub F.
        • Sayed D.
        • et al.
        A multicenter real-world review of 10 kHz SCS outcomes for treatment of chronic trunk and/or limb pain.
        Ann Clin Transl Neurol. 2019; 6: 496-507
        • Kapural L.
        • Gupta M.
        • Paicius R.
        • et al.
        Treatment of chronic abdominal pain with 10-kHz spinal cord stimulation.
        Clin Transl Gastroenterol. 2020; 11e00133
        • Deer T.
        • Slavin K.V.
        • Amirdelfan K.
        • et al.
        Success using neuromodulation with BURST (SUNBURST) study: results from a prospective, randomized controlled trial using a novel burst waveform.
        Neuromodulation. 2018; 21: 56-66
        • Chakravarthy K.
        • Malayil R.
        • Kirketeig T.
        • Deer T.
        Burst spinal cord stimulation: a systematic review and pooled analysis of real-world evidence and outcomes data.
        Pain Med. 2019; 20: S47-S57
        • Hallal P.C.
        • Andersen L.B.
        • Bull F.C.
        • Guthold R.
        • Haskell W.
        • Ekelund U.
        Global physical activity levels: surveillance progress, pitfalls, and prospects.
        Lancet. 2012; 380: 247-257
        • Azevedo M.R.
        • Araújo C.L.P.
        • Reichert F.F.
        • Siqueira F.V.
        • da Silva M.C.
        • Hallal P.C.
        Gender differences in leisure-time physical activity.
        Int J Public Health. 2007; 52: 8-15
        • Lee Y.-S.
        Gender differences in physical activity and walking among older adults.
        J Women Aging. 2005; 17: 55-70
        • Cecchi F.
        • Debolini P.
        • Lova R.M.
        • et al.
        Epidemiology of back pain in a representative cohort of Italian persons 65 years of age and older.
        Spine (Phila Pa 1976). 2006; 31: 1149-1155
        • Ho A.
        • Ashe M.C.
        • DeLongis A.
        • Graf P.
        • Khan K.M.
        • Hoppmann C.A.
        Gender differences in pain-physical activity linkages among older adults: lessons learned from daily life approaches.
        Pain Res Manag. 2016; 2016: 1-9
        • Sullivan M.J.L.
        • Thorn B.
        • Haythornthwaite J.A.
        • et al.
        Theoretical perspectives on the relation between catastrophizing and pain.
        Clin J Pain. 2001; 17: 52-64
        • Nahman-Averbuch H.
        • Dayan L.
        • Sprecher E.
        • et al.
        Sex differences in the relationships between parasympathetic activity and pain modulation.
        Physiol Behav. 2016; 154: 40-48
        • Munce S.E.P.
        • Stewart D.E.
        Gender differences in depression and chronic pain conditions in a National Epidemiologic Survey.
        Psychosomatics. 2007; 48: 394-399
        • Rosen S.
        • Ham B.
        • Mogil J.S.
        Sex differences in neuroimmunity and pain.
        J Neurosci Res. 2017; 95: 500-508

      Comment