Neuromodulation With Burst and Tonic Stimulation Decreases Opioid Consumption: APost HocAnalysis of the Success Using Neuromodulation WithBURST(SUNBURST) Randomized Controlled Trial

Objective The SUNBURST study was a prospective, multicenter, randomized crossover trial of a single device delivering burst and tonic spinal cord stimulation (SCS) for chronic trunk and/or limb pain. We performed apost hocanalysis of opioid consumption at baseline and after device implantation. Materials and Methods After implantation, 100 patients were randomized to one mode (tonic or burst) for 12 weeks, and the other mode for the subsequent 12 weeks. After the crossover period (24 weeks), patients chose their preferred mode and were assessed for one year. We analyzed 69 patients who took opioid medication at baseline. The primary endpoint was opioid consumption in morphine milligram equivalents (MMEs) at baseline and 12 months postimplantation. Subgroup analysis included opioid consumption based on Center for Disease Control markers (<50, 50-90, 90-120, >120 MME/day) and stimulation mode preference. Results Opioid consumption at 12 months was lower compared to baseline (53.94 vs. 79.19 MME, MD -25.25, 95% CI -43.77 to 6.73,p= 0.008). By 12 months, 11 of 69 patients (15.9%) discontinued all opioid (p= 0.001). Based on CDC dose markers, the proportion of patients taking >120 MME/day decreased by 61.7% at 12 months postintervention compared to baseline (p= 0.043). Forty-five of 69 patients (65.2%) preferred burst SCS while 15 of 69 patients (21.7%) preferred tonic SCS (p < 0.001). Conclusion A device delivering tonic and burst SCS was associated with decreased opioid consumption after 12 months in patients with chronic trunk and/or limb pain. The proportion of patients reporting the highest opioid intake (>120 MME/day) decreased to a lower CDC dose category by 61.7%, carrying important implications for those at highest risk for opioid-related substance use disorder, overdose, and death.