Pluijms Wouter A, Slangen Rachel, van Kleef Maarten, Joosten Elbert A, Reulen Jos P H
Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
Neuromodulation. 2015 Feb;18(2):126-32; discussion 132. doi: 10.1111/ner.12188. Epub 2014 Jun 19.
To analyze sensory characteristics and small nerve fiber function in patients suffering from painful diabetic polyneuropathy (PDP) and compare outcomes in responders and nonresponders to SCS treatment.
Fifteen patients with intractable PDP in the legs were recruited. If trial stimulation resulted in clinically relevant pain relief, a pulse generator was implanted and pain scores were measured after 12 months. Sensory characteristics (modified Inflammatory Neuropathy Cause and Treatment [md-INCAT] sum score) and small nerve fiber function (contact heat evoked potentials, CHEPs) were measured before implantation (D1), and CHEP measurement was repeated after two weeks of trial stimulation (D2). Outcomes in responders (N = 10) and nonresponders (N = 5) to SCS treatment were compared. Data were analyzed using nonparametric statistics.
At one year, clinically relevant pain relief was achieved in 10 out of 15 patients. The md-INCAT score did not differ between SCS responders and nonresponders (8.0 vs. 5.0; p = 0.59). No differences were found in CHEP outcomes at D1 vs. D2, except for dorsal forearm P2 latency, and the correlation between D1 and D2 CHEP outcomes was high. Volar N2 forearm latency (0.492 vs. 0.434; p < 0.01), dorsal forearm N2 latency (0.518 vs. 0.453; p = 0.04), and dorsal forearm P2 latency (0.660 vs. 0.589; p = 0.04) were increased in SCS responders as compared with SCS nonresponders.
From this small-scale clinical pilot study we conclude that forearm CHEP latencies are increased in PDP patients who respond to SCS therapy as compared with SCS nonresponders. Before the CHEP latency can be used as a predictor of SCS outcome in PDP patients, a large-scale study is needed.
分析痛性糖尿病性多发性神经病（PDP）患者的感觉特征和小神经纤维功能，并比较脊髓刺激（SCS）治疗有反应者和无反应者的治疗结果。
招募15例腿部顽固性PDP患者。如果试验性刺激导致临床上有意义的疼痛缓解，则植入脉冲发生器，并在12个月后测量疼痛评分。在植入前（D1）测量感觉特征（改良炎症性神经病病因与治疗[md-INCAT]总分）和小神经纤维功能（接触热诱发电位，CHEP），并在试验性刺激两周后重复测量CHEP（D2）。比较SCS治疗有反应者（N = 10）和无反应者（N = 5）的治疗结果。使用非参数统计分析数据。
1年时，15例患者中有10例实现了临床上有意义的疼痛缓解。SCS有反应者和无反应者之间的md-INCAT评分无差异（8.0对5.0；p = 0.59）。除了前臂背侧P2潜伏期外，D1与D2时CHEP结果无差异，且D1和D2时CHEP结果之间的相关性很高。与SCS无反应者相比，SCS有反应者的掌侧前臂N2潜伏期（0.492对0.434；p < 0.01）、前臂背侧N2潜伏期（0.518对0.453；p = 0.04）和前臂背侧P2潜伏期（0.660对0.589；p = 0.04）增加。
从这项小规模临床试点研究中我们得出结论，与SCS无反应者相比，对SCS治疗有反应的PDP患者的前臂CHEP潜伏期增加。在CHEP潜伏期可作为PDP患者SCS治疗结果的预测指标之前，需要进行大规模研究。
