Chronic Pain: Sex Differences in Pain Relief from High vs Low Spinal Cord Stimulation

PainRelief.com: What should readers take away from your report?

Response: We examined 237 patients who had received SCS treatment between 2004 and 2020: 94 patients (40 females, 54 males) who received High Frequency-SCS and 143 patients (70 females and 73 males) who received Low Frequency-SCS. 

At three and six months post-implantation, we found that perceived pain relief across all patients improved compared to baseline, but High Frequency-SCS produced greater PPR than Low Frequency-SCS. High Frequency-SCS was also associated with less subsequent use of opioids to mitigate pain.

However, there were differences in the findings between sexes:

  • Male perceived pain relief, for example, was significantly better for High Frequency SCS at three and six months when compared to Low Frequency SCS, while this was only true for females at the 6 month time point.
  • Low Frequency SCS treated males used more opioids post-implantation and at six months when compared to High Frequency SCS treated males. 
  • While overall Low Frequency SCS treated females used significantly more opioids at the post-implantation three and six month visit,  and then tended to continue to use more opiates at the 12-month visit, when compared to High Frequency SCS treated females. 

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: This study is a first step in the right direction, but clearly more work needs to be done.  We need to carefully characterize sex specific pain regulatory pathways that may prove responsive to specific types of neuromodulation and or combinations of pharmaceutical therapies.

Any disclosures?

I do have had funded research from NEVRO, and Boston Scientific in the past.  I am Chief Scientific Officer of the company InflammSense LLC. 

Citation:

Rosalynn R. Z. Conic, Jacob Caylor, Christina L. Cui, Zabrina Reyes, Eric Nelson, Sopyda Yin, Imanuel Lerman. Sex-specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic pain. Bioelectronic Medicine, 2022; 8 (1) DOI: 10.1186/s42234-022-00090-2

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