Knezevic Nebojsa N, Candido Kenneth D, Rana Shalini, Knezevic Ivana
Pain Physician. 2015 Jul-Aug;18(4):E643-50.
The prevalence of HIV-related neuropathy may rise nationwide as Highly Active Antiretroviral Therapy (HAART) usage and HIV-survival rates increase, resulting in higher referral rates to pain practitioners for analgesic strategies. However, if patients' symptoms are refractory to conservative measures, an advanced interventional approach may be indicated.
We present 2 cases of successful use of spinal cord neuromodulation in the treatment of HIV-related neuropathy.
Case Report.
One patient experienced severe lower extremity burning pain, progressively worsening over the past 6 years. He had trouble ambulating, and pain was refractory to conservative treatments. The other patient suffered from low back pain and distal symmetrical polyneuropathy. A remote lumbar discectomy prior to his development of HIV disease resulted in marked improvement in lumbar spinal pain, but subsequent later development of neuropathic pain remained refractory to different treatment modalities.
Both patients reported more than 90% improvement in pain during the spinal cord stimulator (SCS) trial, which led to permanent SCS implantation with equivalent success rates. One of them was followed up for 3 years, and another one for 14 months before he moved overseas. Both of them reported an improved quality of life, reductions in the use of oral opioid analgesics, and increased ability to participate in daily activities without limitations. Neither patient sustained any infectious complications, lead migration, or required battery changes.
Controlled double blinded studies with a higher number of patients are needed to prove efficacy in these patients.
These 2 cases demonstrate that SCS neuromodulation is a safe, viable, and efficacious option for patients whose HIV-related neuropathic type pain is refractory to conventional treatment modalities. Our patients appear to be the first case reports that show a remarkable efficacy of SCS in the management of HIV-related polyneuropathy.
随着高效抗逆转录病毒疗法（HAART）的使用增加以及艾滋病毒存活率提高，全国范围内与艾滋病毒相关的神经病变患病率可能会上升，导致因镇痛策略而转诊至疼痛治疗医生处的比例更高。然而，如果患者的症状对保守治疗无效，则可能需要采用先进的介入方法。
我们介绍2例成功使用脊髓神经调节治疗与艾滋病毒相关神经病变的病例。
病例报告。
一名患者经历了严重的下肢灼痛，在过去6年中逐渐加重。他行走困难，疼痛对保守治疗无效。另一名患者患有腰痛和远端对称性多发性神经病变。在感染艾滋病毒之前进行的一次远程腰椎间盘切除术使腰椎疼痛明显改善，但随后出现的神经性疼痛对不同治疗方式仍无反应。
两名患者在脊髓刺激器（SCS）试验期间均报告疼痛改善超过90%，这导致永久性SCS植入，成功率相当。其中一名患者随访了3年，另一名患者在移居海外前随访了14个月。他们两人均报告生活质量改善，口服阿片类镇痛药的使用减少，参与日常活动的能力增强且不受限制。两名患者均未出现任何感染并发症、导线移位或需要更换电池。
需要更多患者的对照双盲研究来证明对这些患者的疗效。
这2例病例表明，对于与艾滋病毒相关的神经性疼痛对传统治疗方式无效的患者，SCS神经调节是一种安全、可行且有效的选择。我们的患者似乎是首批显示SCS在治疗与艾滋病毒相关的多发性神经病变方面具有显著疗效的病例报告。
