Rauck Richard L, Cohen Steven P, Gilmore Christopher A, North James M, Kapural Leonardo, Zang Rosemary H, Grill Julie H, Boggs Joseph W
Carolinas Pain Institute, Winston-Salem, NC, USA; The Center for Clinical Research, Winston-Salem, NC, USA.
Neuromodulation. 2014 Feb;17(2):188-97. doi: 10.1111/ner.12102. Epub 2013 Aug 15.
Present treatment methods are often unsatisfactory in reducing post-amputation pain. Peripheral nerve stimulation (PNS) could reduce the pain, but it is rarely used because present methods require invasive surgical access and precise placement of the leads in close proximity (≤ 2 mm) with the nerve.
The present study investigated the feasibility of delivering PNS to patients with moderate-to-severe post-amputation pain in the lower extremity using a fine-wire lead placed percutaneously under ultrasound guidance a remote distance (0.5-3.0 cm) away from the sciatic and/or femoral nerves.
Fourteen of the 16 subjects who completed in-clinic testing responded to stimulation, reported ≥ 75% paresthesia coverage, obtained clinically significant pain relief, and proceeded to a two-week home trial with a percutaneous PNS system. Two of the 14 responders had their leads removed early because of accidental dislodgement (N = 2), two had temporary discomfort near the lead (N = 2), and one had return of post-amputation pain despite stimulation (N = 1) and did not complete the home trial. The nine responders who completed the home trial reported reductions in their mean daily worst post-amputation pain (56 ± 26%, 56 ± 26%, N = 9), average residual limb pain (72 ± 28%, 42 ± 27%, N = 7), average phantom limb pain (81 ± 28%, 47 ± 48%, N = 7), residual limb pain interference (81 ± 27%, 53 ± 17%, N = 6), phantom limb pain interference (83 ± 31%, 56 ± 46%, N = 7), and Pain Disability Index (70 ± 38%, 55 ± 32%, N = 9) during the second week of stimulation and four weeks after the end of stimulation, respectively. All nine responders rated their change in quality of life as improved at the end of stimulation and at the end of the four-week follow-up period. Subjects reported minor decreases in the Beck Depression Inventory scores (43 ± 51%, 32 ± 57%, N = 9). Most subjects had no substantial changes other than minor decreases (N = 3) in pain medication.
Achievement of significant pain relief and improvements in quality of life with a minimally invasive method of PNS holds promise for providing relief of post-amputation pain.
目前的治疗方法在减轻截肢后疼痛方面往往不尽人意。外周神经刺激（PNS）可以减轻疼痛，但很少使用，因为目前的方法需要进行侵入性手术，并且电极需要精确放置在离神经很近（≤2毫米）的位置。
本研究调查了在超声引导下经皮将细线电极放置在离坐骨神经和/或股神经较远（0.5 - 3.0厘米）的位置，对中重度下肢截肢后疼痛患者进行PNS治疗的可行性。
16名完成门诊测试的受试者中，有14名对刺激有反应，报告感觉异常覆盖范围≥75%，获得了临床上显著的疼痛缓解，并继续使用经皮PNS系统进行为期两周的家庭试验。14名有反应的受试者中，有2名因电极意外移位（N = 2）而提前取出电极，2名在电极附近有短暂不适（N = 2），1名尽管接受刺激但仍出现截肢后疼痛复发（N = 1），未完成家庭试验。完成家庭试验的9名有反应的受试者报告，在刺激的第二周和刺激结束四周后，他们的平均每日最严重截肢后疼痛分别减轻了（56±26%，56±26%，N = 9），平均残肢疼痛减轻了（72±28%，42±27%，N = 7），平均幻肢疼痛减轻了（81±28%，47±48%，N = 7），残肢疼痛干扰减轻了（81±27%，53±17%，N = 6），幻肢疼痛干扰减轻了（83±31%，56±46%，N = 7），疼痛残疾指数分别减轻了（70±38%，55±32%，N = 9）。所有9名有反应的受试者在刺激结束时和四周随访期结束时均将他们的生活质量变化评为有所改善。受试者报告贝克抑郁量表得分略有下降（43±51%，32±57%，N = 9）。除了疼痛药物略有减少（N = 3）外，大多数受试者没有实质性变化。
采用微创PNS方法实现显著的疼痛缓解和生活质量改善，有望为截肢后疼痛提供缓解。
