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Dissociation between reduced pain and arterial blood pressure following epidural spinal cord stimulation in patients with chronic pain: A retrospective study

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Abstract

Purpose

Acute pain and resting arterial blood pressure (BP) are positively correlated in patients with chronic pain. However, it remains unclear whether treatment for chronic pain reduces BP. Therefore, in a retrospective study design, we tested the hypothesis that implantation of an epidural spinal cord stimulator (SCS) device to treat chronic pain would significantly reduce clinic pain ratings and BP and that these reductions would be significantly correlated.

Methods

Pain ratings and BP in medical records were collected before and after surgical implantation of a SCS device at the University of Iowa Hospitals and Clinics between 2008 and 2018 (n = 213).

Results

Reductions in pain rating [6.3 ± 2.0 vs. 5.0 ± 1.9 (scale: 0–10), P < 0.001] and BP [mean arterial pressure (MAP) 95 ± 10 vs. 89 ± 10 mmHg, P < 0.001] were statistically significant within 30 days of SCS. Interestingly, BP returned toward baseline within 60 days following SCS implantation. Multiple linear regression analysis showed that sex (P = 0.007), baseline MAP (P < 0.001), and taking hypertension (HTN) medications (P < 0.001) were significant determinants of change in MAP from baseline (Δ MAP) (model R2 = 0.33). After statistical adjustments, Δ MAP was significantly greater among women than among men ( − 7.2 ± 8.5 vs.  − 3.9 ± 8.5 mmHg, P = 0.007) and among patients taking HTN medications than among those not taking hypertension medications ( − 10.1 ± 8.7 vs.  − 3.9 ± 8.5 mmHg, P < 0.001), despite no group differences in change in pain ratings.

Conclusions

Together, these findings suggest that SCS for chronic pain independently produces clinically meaningful, albeit transient, reductions in BP and may provide a rationale for studies aimed at reducing HTN medication burden among this patient population.

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Acknowledgements

We would like to acknowledge the Institute for Clinical and Translational Science (ICTS) for their assistance with data collection using TriNetX, and continued support from the Department of Neurosurgery at the University of Iowa.

Funding

This work was supported in part by the Iowa Cardiovascular Interdisciplinary Research Fellowship (T32HL007121) (SWH), American Heart Association grants 17POST33440101 (SWH) and 13SDG143400012 (GLP), and ICTS grant UL1TR002537 NIH research program grant P01 HL014388-48 (FMA, GLP, JGF).

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Authors and Affiliations

  1. Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas, KS, 66160-7415, US

    Seth W. Holwerda

  2. Department of Neurosurgery, University of Iowa, Iowa City, IA, US

    Marshall T. Holland

  3. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK

    Alexander L. Green

  4. Department of Anesthesia, University of Iowa, Iowa City, IA, US

    Amy C. S. Pearson

  5. Department of Health and Human Physiology, University of Iowa, Iowa City, IA, US

    Gary L. Pierce

  6. Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA, US

    Gary L. Pierce

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  1. Seth W. Holwerda
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Contributions

All authors of this research paper have directly participated in the study’s conception and design, the drafting and revision of this paper, and final approval of the version to be published.

Corresponding author

Correspondence to Seth W. Holwerda.

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Conflict of interest

The authors have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter discussed in this manuscript. A patent is currently pending for use of epidural spinal cord stimulation to increase peripheral blood flow (SWH, MTH, GLP).

Ethical approval

This study was conducted according to the guidelines laid down by the Declaration of Helsinki of 1964, as revised in 2013, and all procedures were approved by the Institutional Review Board (IRB) at the University of Iowa (Project#: 201,805,969). Waiver of informed consent was granted by the institutional review board (IRB).

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Holwerda, S.W., Holland, M.T., Green, A.L. et al. Dissociation between reduced pain and arterial blood pressure following epidural spinal cord stimulation in patients with chronic pain: A retrospective study. Clin Auton Res 31, 303–316 (2021). https://doi.org/10.1007/s10286-020-00690-5

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  • DOI: https://doi.org/10.1007/s10286-020-00690-5

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