Spinal cord stimulation and return to work of patients with failed back surgery syndrome.

OBJECTIVES: Chronic pain has a substantial negative impact on work-related outcomes, which underlines the importance of interventions to reduce the burden. Spinal cord stimulation (SCS) efficiently relieves pain in specific chronic pain syndromes and is recommended for treating failed back surgery syndrome (FBSS) or post-surgical chronic back pain that is refractory to other treatments. To examine the impact of SCS in patients with FBSS on the return to work (RTW), we determined the RTW rate and the factors positively associated with the RTW. MATERIALS AND METHODS: Among 106 patients with FBSS who benefitted from SCS at a single institution in France between September 1999 and March 2010, we retrospectively included 59 who had stopped work at the time of SCS because of disability or sick leave and evaluated the RTW (rate and predictors, estimating odds ratios [ORs] and 95% confidence intervals [CIs]). RESULTS: The mean (SD) post-surgery follow-up for the 59 patients (34 men; mean [SD] age 46.9 [7.4] years) was 7.5 (3.6) years (range 5-15). The RTW rate was 30.5%, with a median [IQR] recovery time of 5.5 months [3-8.5]. RTW was improved with functional improvement evolution (OR 1.1, 95% CI [1.01-1.1], p = 0.02) and was reduced with unemployment > 3 years (OR 0.1, 95% CI [0.01-0.7], p = 0.02). CONCLUSIONS: Our protocol for SCS for patients with FBSS, including a strict selection of patients and a multidisciplinary approach, led to good results, especially for the RTW. RTW should be a therapeutic goal, directly affecting indirect costs related to FBSS.

[Pain and dementia]. / Douleur et démence.

Dementia and pain are both common in the elderly and then frequently associated. The literature review shows that pain in dementia is underdiagnosed and consequently undertreated. This can be linked to: 1) the difficulty of pain assessment in patients with cognitive disorders and altered communication skills; 2) changes of pain processing and especially in the motivational-affective domain; 3) modified efficacy of analgesic drugs. This has been documented in Alzheimer's disease but remains to be investigated in the other types of dementia in order that all patients can be treated whatever their diagnosis, illness duration and type of pain (acute versus chronic).