Spinal Cord Stimulation - Device Revision After Weight Loss in a Patient on Chronic Semaglutide - A Case Report.

BACKGROUND: Spinal cord stimulation (SCS) is an effective treatment option for patients suffering from chronic intractable pain of the trunk and/or limbs. One of the potential adverse effects of SCS is discomfort or pain at the site of the implantable pulse generator (IPG). It is a known phenomenon that patient weight loss may exacerbate or increase discomfort or pain at the IPG implantation site. OBJECTIVE: This case report aims to educate neuromodulation clinicians on the potential impact of glucagon-like peptide-1 receptor agonists (GLP-1RA) medications on patient weight loss and decreased subcutaneous adipose tissue stores post-SCS system implant, necessitating lead anchor or IPG pocket revision. STUDY DESIGN: Case Report. CONCLUSION: The usage of GLP-1RA medications for diabetes or weight loss therapy continues to increase as does the use of implantable SCS systems for the management of chronically painful conditions. Interventional pain management or neuromodulation clinicians should be well-educated on the indications for use of GLP-1RA medications and their associated mechanisms of action, which may lead to weight loss, decreased subcutaneous adipose tissue stores, and muscle wasting, potentially impacting the comfortability of SCS devices. Pre-screening for the use of GLP-1RA medications should occur prior to SCS implant, and clinicians should plan accordingly to minimize the potential for SCS lead anchor or IPG pocket site discomfort. Further, patient's body habitus and adipose tissue stores should be taken into consideration when planning for IPG pocket site location.