Van Boxem Koen, de Meij Nelleke, Kessels Alfons, Van Kleef Maarten, Van Zundert Jan
Department of Anesthesiology & Pain Management, Maastricht University Medical Center MUMC, Maastricht, The Netherlands.
Department of Anesthesiology - Critical Care and Multidisciplinary Pain Center, Sint-Jozefkliniek Bornem & Willebroek, Bornem, Belgium.
Pain Med. 2015 Jun;16(6):1155-62. doi: 10.1111/pme.12670. Epub 2015 Jan 8.
There is little evidence concerning the medical management of lumbosacral radicular pain. The prognosis for patients suffering pain for more than 3 months is poor. Pulsed radiofrequency (PRF) treatment of the dorsal root ganglion (DRG) has been suggested as a minimally invasive treatment. We studied the effect on pain and quality of life of PRF treatment of the DRG in patients with chronic, severe lumbosacral radicular pain.
Patients with lumbosacral radicular pain were screened to select a homogeneous population. PRF treatment of the DRG was performed at L5 or S1. Evaluation was carried out at 6 weeks, 3 months, and 6 months. Pain reduction and "fully recovered" or "much improvement," in terms of the global perceived effect, were the primary outcomes. Quality of life (RAND-36), disability (Oswestry Disability Index), and the neuropathic pain scales leeds assessment of neuropathic symptoms and signs (LANSS) and DN4 were registered at each time point. Medication use was scored with the Medication Quantification Scale.
Out of 461 screened patients, 65 were included. According to the intention to treat analysis, clinical success was achieved in 56.9%, 52.3%, and 55.4% of the patients at respectively 6 weeks, 3 months, and 6 months. DN4, Oswestry Disability Index and physical component for the RAND-36 quality of life improved significantly while the mental component remained unchanged. The number of patients on opioids was reduced.
PRF treatment of the DRG may be considered for patients with chronic, severe lumbosacral radicular pain refractory to conventional medical management.
关于腰骶神经根性疼痛的药物治疗，几乎没有相关证据。疼痛超过3个月的患者预后较差。脉冲射频（PRF）治疗背根神经节（DRG）已被提议作为一种微创治疗方法。我们研究了PRF治疗DRG对慢性、重度腰骶神经根性疼痛患者疼痛及生活质量的影响。
对腰骶神经根性疼痛患者进行筛查以选择同质化人群。在L5或S1水平对DRG进行PRF治疗。分别在6周、3个月和6个月时进行评估。主要结局是根据整体感知效果评估疼痛减轻情况以及“完全恢复”或“明显改善”。在每个时间点记录生活质量（RAND-36）、残疾程度（Oswestry残疾指数）以及神经性疼痛量表利兹神经性症状和体征评估（LANSS）和DN4。使用药物量化量表对药物使用情况进行评分。
在461例筛查患者中，65例被纳入。根据意向性分析，在6周、3个月和6个月时，分别有56.9%、52.3%和55.4%的患者取得了临床成功。DN4、Oswestry残疾指数以及RAND-36生活质量的身体成分显著改善，而心理成分保持不变。使用阿片类药物的患者数量减少。
对于传统药物治疗无效的慢性、重度腰骶神经根性疼痛患者，可考虑采用PRF治疗DRG。
