Effect of HF-Spinal Cord Stimulation on Chronic Pain Varies by Sex

High-frequency spinal cord stimulation (HF-SCS) shows longer lasting pain relief than low-frequency (LF) SCS but with some sex-specific differences in effectiveness for treating chronic pain, according to a study published online April 28 in Bioelectronic Medicine.

Rosalynn R.Z. Conic, MD, PhD, from the University of California in San Diego, and colleagues evaluated sex‑specific differences in the efficacy of traditional LF-SCS versus HF-SCS for chronic pain. Analysis included 94 patients with HF-SCS (10 kHz) and 143 with LF-SCS (50 Hz) receiving implants between 2004 and 2020.

The researchers found that at 3 months and 6 months, HF-SCS and LF-SCS patients had lower visual analog scores versus baseline, with no differences across groups. For HF-SCS, perceived pain reduction (PPR) improved for both genders at postimplantation and at 3 months, versus baseline and persisted to 6 and 12 months. Compared to LF-SCS, male PPR was significantly better for HF-SCS at 3 and 6 months, while improvement for women was only seen at the 6-month time point. For opioid use, there were no differences from baseline for either modality; however, LF-SCS patients used more opioids at every time point versus HF-SCS.

“Our work was sparked by a growing literature that demonstrate sex-specific immune pathways differentially contribute to chronic pain processes,” a coauthor said in a statement. “The observed parameter-specific (high versus low frequency) sex-based differences in spinal cord stimulation efficacy and opiate use are definitely intriguing.”

One author disclosed financial ties to the medical technology industry.