Mobbs R J, Nair S, Blum P
Department of Neurosurgery, Institute of Neurological Sciences, The Prince of Wales Hospital, Randwick, Sydney, Australia.
J Clin Neurosci. 2007 Mar;14(3):216-21; discussion 222-3. doi: 10.1016/j.jocn.2005.11.007.
The aim of this retrospective study is to evaluate the role of the implanted peripheral nerve stimulator in patients with pain in a peripheral nerve distribution. The current study is the largest in the literature that examines the role of the implantable peripheral nerve stimulator in the chronic pain patient. Our patient sample included 38 patients (with 41 nerve stimulators), consisting of 19 males and 19 females with a mean age of 44 years (SD=11 years). Four groups of etiologic factors were identified; blunt or sharp nerve trauma (14/38), iatrogenic injuries from surgery (9/38), inadvertent injection of a nerve (9/38) and post surgery for entrapment or tumour (8/38). Stimulation was attempted in 45 patients, but an initial trial failed in 4. Mean follow-up time from implantation of the stimulator was 31 months (SD=19 months). Compensation benefit was an issue in 29 cases (76%). Outcome following implantation was assessed based on pain criteria, narcotic usage and return to normal function/ work. Relief from preoperative pain was judged as good (>50% relief) by 23/38 patients (61%). A total of 15 patients reported fair or poor results (39%). Six patients required removal of their stimulators (15%) due to infection or reduction of pain control after an initial good result. A statistically significant decrease in reported pain level was found postoperatively (p<0.05). Workers' compensation patients have equivalent outcomes to non-compensable patients (p>0.05). Eighteen of 38 (47%) patients reported a significant improvement in their activity levels following stimulator implant. In conclusion, over 60% of patients had a significant improvement in their pain and lifestyle following implantation of peripheral nerve stimulators. We therefore conclude that peripheral nerve stimulation can be useful in decreasing pain in well selected patients with severe pain in the distribution of a peripheral nerve.
这项回顾性研究的目的是评估植入式外周神经刺激器在患有外周神经分布区域疼痛患者中的作用。当前的研究是文献中规模最大的，探讨了植入式外周神经刺激器在慢性疼痛患者中的作用。我们的患者样本包括38名患者（共植入41个神经刺激器），其中19名男性和19名女性，平均年龄44岁（标准差=11岁）。确定了四组病因；钝性或锐性神经损伤（14/38）、手术引起的医源性损伤（9/38）、意外神经注射（9/38）以及因卡压或肿瘤进行手术后（8/38）。对45名患者尝试进行刺激，但4名患者的初始试验失败。从刺激器植入到随访的平均时间为31个月（标准差=19个月）。29例（76%）涉及赔偿问题。根据疼痛标准、麻醉药物使用情况以及恢复正常功能/工作来评估植入后的结果。23/38名患者（61%）术前疼痛缓解良好（缓解>50%）。共有15名患者报告结果一般或较差（39%）。6名患者（15%）因感染或在最初效果良好后疼痛控制减弱而需要取出刺激器。术后报告的疼痛水平有统计学显著下降（p<0.05）。工伤赔偿患者与非赔偿患者的结果相当（p>0.05）。38名患者中有18名（47%）报告在植入刺激器后活动水平有显著改善。总之，超过60%的患者在植入外周神经刺激器后疼痛和生活方式有显著改善。因此，我们得出结论，外周神经刺激对于精心挑选的外周神经分布区域严重疼痛患者减轻疼痛可能是有用的。
