Pain Management Department, Anesthesia Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Neuromodulation. 2011 Sep-Oct;14(5):423-6; discussion 426-7. doi: 10.1111/j.1525-1403.2011.00381.x. Epub 2011 Aug 19.
Spinal cord stimulation (SCS) may reduce pain scores and improve function in patients with various chronic abdominal pain syndromes including chronic pancreatitis. Here described is a large clinical experience in SCS for severe chronic pancreatitis.
SCS was trialed in 30 patients with chronic pancreatitis. SCS trials lasted 7-14 days (median 9 days). SCS lead tips were mostly positioned at the T5 (N= 10) or T6 (N= 10) vertebral level.
Twenty-four patients (80%) reported at least 50% pain relief on completion of the trial. Among these, pre-trial visual analog scale (VAS) pain scores averaged 8 ± 1.6 (standard deviation) and opioid use averaged 165 ± 120 mg morphine sulfate equivalents. During the trial, VAS pain scores decreased to 3.67 ± 2 cm (p < 0.001, Mann-Whitney Rank Sum Test) and opioid use decreased to 105 ± 101 mg morphine equivalent a day. Six patients failed the trial; one was lost to follow-up; in three patients after the implantation, the system had to be removed due to infection or lead migration; and 20 were followed for the whole year. For 20 patients followed for the whole year, VAS pain scores remained low (3.6 ± 2 cm; p < 0.001) at one year, as did opioid use (48.6 ± 58 mg morphine equivalents).
SCS may be a useful therapeutic option for patients with severe visceral pain from chronic pancreatitis. Prospective trial is warranted.
脊髓刺激（SCS）可能会降低各种慢性腹痛综合征（包括慢性胰腺炎）患者的疼痛评分并改善其功能。这里描述的是 SCS 在严重慢性胰腺炎中的大量临床经验。
对 30 例慢性胰腺炎患者进行了 SCS 试验。SCS 试验持续 7-14 天（中位数 9 天）。SCS 导联尖端大多位于 T5（N=10）或 T6（N=10）椎骨水平。
24 例患者（80%）在试验结束时报告至少 50%的疼痛缓解。其中，术前视觉模拟量表（VAS）疼痛评分平均为 8±1.6（标准差），阿片类药物使用平均为 165±120mg 硫酸吗啡当量。在试验过程中，VAS 疼痛评分降至 3.67±2cm（p<0.001，Mann-Whitney 秩和检验），阿片类药物使用量降至 105±101mg 吗啡当量/天。6 例患者试验失败；1 例失访；3 例患者在植入后因感染或导联移位而不得不移除系统；20 例患者接受了全年随访。对于 20 例接受全年随访的患者，VAS 疼痛评分在一年后仍然较低（3.6±2cm；p<0.001），阿片类药物使用量（48.6±58mg 吗啡当量）也保持不变。
SCS 可能是治疗慢性胰腺炎严重内脏疼痛患者的有用治疗选择。需要进行前瞻性试验。
