Mortality Outcomes After Spinal Cord Stimulation: A 10-Year Survival Analysis of 330 Patients With Chronic Neuropathic Pain

BACKGROUND AND OBJECTIVES: Spinal cord stimulation (SCS) is an established but intricate therapy for neuropathic pain. Chronic pain is associated with increased mortality; however, the impact of successful SCS treatment on mortality remains unreported. In this retrospective case-controlled study, we present survival and cause-specific mortality data for patients trialed for SCS. METHODS: The primary outcome was cause-specific mortality in our cohort of 330 consecutive patients, aged 65 years or younger, referred to Kuopio University Hospital for persistent spinal pain syndrome type 2, complex regional pain syndrome, or other neuropathic pain. An SCS device was implanted in 256 patients but later explanted in 78 cases. To compare mortality, 979 matched controls and causes of death were sourced from a national registry. RESULTS: During a median follow-up of 9.1 years, 28 patients and 39 matched controls died. The 10-year mortality rate was increased in the trial-only group (hazard ratio [HR] = 2.34; CI 1.11-5.09, P = .03) and the explanted SCS group (HR = 3.57; CI 1.83-6.98, P < .001), whereas no increased mortality was observed in the permanent SCS group compared with matched controls (HR = 1.41; CI 0.68-2.91, P = .35). The most frequent causes of death were malignant neoplasms (27%) and external causes (27%). CONCLUSION: Increased mortality was observed in patients with a negative SCS trial or explanted SCS devices, whereas patients with successful SCS treatment experienced no excess mortality.