Pain Medication Tapering for Patients With Persistent Spinal Pain Syndrome Type 2, Treated With Spinal Cord Stimulation.

This study tests a structured opioid tapering program for patients with persistent spinal pain after back surgery who are being treated with spinal cord stimulation (SCS). Many patients with failed back surgery syndrome become dependent on opioid pain medications, but opioids can blunt the effectiveness of spinal cord stimulation. This trial evaluates whether a guided, medication-assisted taper — using drugs like buprenorphine/naloxone and clonidine to manage withdrawal — can help patients successfully reduce or stop opioids while their pain is managed by SCS. Eligible participants are adults with neuropathic leg and/or back pain after at least one spine surgery, scheduled for spinal cord stimulator implantation, and currently taking opioids. Participants must speak Dutch or French. People being treated for active cancer, with terminal illness, receiving intrathecal drug delivery, or with contraindications to the tapering medications are excluded. Participants follow the tapering protocol and are monitored for pain scores, opioid use, and quality of life. This research addresses a significant problem in chronic pain management: many patients after back surgery end up on long-term opioids with diminishing returns, and spinal cord stimulation works better when opioid use is reduced. A systematic, safe tapering protocol could help patients achieve better pain control with lower medication burden.