Albert Schweitzer Hospital, Pain Treatment Center, Dordrecht, The Netherlands.
Neuromodulation. 2012 Mar-Apr;15(2):108-16; discussion 116-7. doi: 10.1111/j.1525-1403.2011.00393.x. Epub 2011 Sep 21.
OBJECTIVE: The objective of this study was to demonstrate the efficacy of subcutaneous stimulation (SubQ) as an additional therapy in patients with failed back surgery syndrome (FBSS) with chronic refractory pain, for whom spinal cord stimulation (SCS) was unsuccessful in treating low back pain. STUDY DESIGN: Case series. MATERIALS AND METHODS: FBSS patients with chronic limb and/or low back pain whose conventional therapies had failed received a combination of SCS (8-contact Octad lead) and/or SubQ (4-contact Quad Plus lead(s)). Initially leads were placed in the epidural space for SCS for a trial stimulation to assess response to suppression of limb and low back pain. Where SCS alone was insufficient in treating lower back pain, leads were placed superficially in the subcutaneous tissue of the lower back, directly in the middle of the pain area. A pulse generator was implanted if patients reported more than 50% pain relief during the trial period. Pain intensity for limb and lower back pain was scored separately, using visual analog scale (VAS). Pain and Quebec Back Pain Disability Scale (QBPDS) after 12-month treatment were compared with pain and QBPDS at baseline. RESULTS: Eleven FBSS patients, five male and six female (age: 51 ± 8 years; mean ± SD), in whom SCS alone was insufficient in treating lower back pain, were included. In nine cases, SubQ was used in combination with SCS to treat chronic lower back and lower extremity pain. In two cases only SubQ was used to treat lower back pain. SCS significantly reduced limb pain after 12 months (VAS(bl) : 62 ± 14 vs. VAS(12m) : 20 ± 11; p= 0.001, N= 8). SubQ stimulation significantly reduced low back pain after 12 months (VAS(bl) : 62 ± 13.0 vs. VAS(12m) : 32 ± 16; p= 0.0002, N= 10). Overall pain medication was reduced by more than 70%. QBPDS improved from 61 ± 15 to 49 ± 12 (p= 0.046, N= 10). Furthermore, we observed that two patients returned to work. CONCLUSION: SubQ may be an effective additional treatment for chronic low back pain in patients with FBSS for whom SCS alone is insufficient in alleviating their pain symptoms.
目的：本研究旨在证明皮下刺激（SubQ）作为一种辅助疗法的疗效，用于治疗脊髓刺激（SCS）治疗下腰痛失败的失败性背部手术综合征（FBSS）伴慢性难治性疼痛患者。
研究设计：病例系列。
材料和方法：慢性肢体和/或下腰痛且常规治疗失败的 FBSS 患者接受 SCS（8 触点 Octad 导联）和/或 SubQ（4 触点 Quad Plus 导联）的联合治疗。最初，将导联放置在硬膜外空间进行 SCS 试验刺激，以评估对肢体和下腰痛的抑制反应。如果患者在试验期间报告疼痛缓解超过 50%，则单独使用 SCS 不足以治疗下腰痛，则将导联放置在下背部的皮下组织中，直接位于疼痛区域的中间。如果患者报告在试验期间疼痛缓解超过 50%，则植入脉冲发生器。分别使用视觉模拟量表（VAS）对肢体和下腰痛的疼痛强度进行评分。治疗 12 个月后的疼痛和魁北克背部疼痛残疾量表（QBPDS）与基线时的疼痛和 QBPDS 进行比较。
结果：11 例 FBSS 患者，5 例男性，6 例女性（年龄：51±8 岁；均值±标准差），单独使用 SCS 不足以治疗下腰痛。在 9 例中，SubQ 与 SCS 联合用于治疗慢性下腰痛和下肢疼痛。在 2 例中，仅使用 SubQ 治疗下腰痛。SCS 治疗 12 个月后显著降低了肢体疼痛（VAS（bl）：62±14 与 VAS（12m）：20±11；p=0.001，N=8）。SubQ 刺激治疗 12 个月后显著降低了下腰痛（VAS（bl）：62±13.0 与 VAS（12m）：32±16；p=0.0002，N=10）。总体疼痛药物用量减少了 70%以上。QBPDS 从 61±15 改善至 49±12（p=0.046，N=10）。此外，我们观察到两名患者重返工作岗位。
结论：SubQ 可能是一种有效的辅助治疗方法，用于治疗单独使用 SCS 不足以缓解疼痛症状的 FBSS 患者的慢性下腰痛。
Neuromodulation. 2011-11-10
J Pain Res. 2014-11-18
Curr Pain Headache Rep. 2014-5
Zotero 插件