Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, The Netherlands.
Eur J Pain. 2010 Feb;14(2):164-9. doi: 10.1016/j.ejpain.2009.10.009. Epub 2009 Nov 25.
BACKGROUND: Spinal cord stimulation (SCS) has proven to be an effective however an invasive and relatively expensive treatment of chronic Complex Regional Pain Syndrome type 1(CRPS-1). Furthermore, in one third of CRPS-1 patients, SCS treatment fails to give significant pain relief and 32-38% of treated patients experience complications. The aim of the current study was to develop effective prognostic factors for prediction of successful outcome of SCS. METHODS AND RESULTS: The study population consisted of 36 chronic CRPS patients enrolled in a randomized controlled trial of SCS efficacy. We analyzed various prognostic factors in the group of patients treated with SCS and compared baseline values of possible predictors of outcome in the successfully treated and the not successfully treated group. Success was defined as Patient Global Perceived Impression of Change score of at least "much improved" and pain reduction of at least 2.5 on a visual-analogue scale (VAS score 0-10). Univariate analyses showed that patient age, duration of the disease, localization of the disease, intensity of the pain, and the presence of mechanical hypoesthesia did not predict SCS success. The mean and maximum value of brush-evoked allodynia proved to be statistically significant predictors of outcome. Using Receiver-Operating Characteristic (ROC) curve analyses of maximum allodynia values, the diagnostic sensitivity for successful SCS was 0.75 and the specificity 0.81. CONCLUSION: Brush-evoked allodynia may be a significant negative prognostic factor of SCS treatment outcome after 1 year in chronic CRPS-1.
背景:脊髓刺激(SCS)已被证明是一种有效的治疗方法,但它是一种侵入性的、相对昂贵的治疗方法,适用于慢性复杂性区域疼痛综合征 1 型(CRPS-1)。此外,在三分之一的 CRPS-1 患者中,SCS 治疗无法显著缓解疼痛,并且 32-38%的治疗患者会出现并发症。本研究的目的是确定有效的预后因素,以预测 SCS 的治疗效果。
方法和结果:研究人群包括 36 名慢性 CRPS 患者,他们参加了 SCS 疗效的随机对照试验。我们分析了 SCS 治疗组中的各种预后因素,并比较了成功治疗组和未成功治疗组中可能的结局预测因子的基线值。成功定义为患者全球感知变化评分至少为“明显改善”,视觉模拟量表(VAS 评分 0-10)上的疼痛减轻至少 2.5。单因素分析显示,患者年龄、疾病持续时间、疾病定位、疼痛强度和机械性感觉迟钝的存在不能预测 SCS 成功。刷诱发痛觉过敏的平均值和最大值被证明是统计学上显著的结局预测因子。使用最大痛觉过敏值的Receiver-Operating Characteristic(ROC)曲线分析,SCS 成功的诊断灵敏度为 0.75,特异性为 0.81。
结论:在慢性 CRPS-1 中,1 年后刷诱发痛觉过敏可能是 SCS 治疗结局的一个重要负性预后因素。
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