Levine Adrian B, Parrent Andrew G, MacDougall Keith W
Department of Clinical Neurological Sciences, Division of Neurosurgery Western University; London, ON, Canada.
Pain Physician. 2016 Jul;19(6):405-12.
Chronic neuropathic groin pain is a common problem. It can arise following surgery or trauma, or spontaneously as part of various pelvic pain syndromes. A number of different stimulation techniques have been reported in the literature to treat this area, but due to the complex anatomy of the region, it can be difficult to target effectively with paresthesias.
In this study we report our results treating patients with chronic neuropathic groin, pelvic, and abdominal pain, using spinal cord stimulation and dorsal nerve root stimulation.
Open label, prospective study that includes all patients treated with a new trial stimulator system at a single center between July 1, 2011, and October 31, 2013.
Academic university neurosurgical pain center, Canada.
Thirty-two patients had trials of spinal cord stimulation and/or dorsal nerve root stimulation in the thoracic or lumbar spine. Patients were evaluated on visual analog scale pain scores, SF-36, and morphine equivalent daily dose. Data were recorded at the pre-implant visit, and 3, 6, and 12 months following permanent implant.
The 15 patients who went on to permanent implants had, on average, significant pain reduction and improvements in quality of life at the 12 month follow-up. The majority of patients who were taking opioids at the initial assessment were able to reduce their dose with treatment. Three patients with successful trials were long-term non-responders, of whom 2 had the permanent device removed.
This study would benefit from a larger sample size that would have adequate power for comparisons between patient subgroups and stimulation techniques.
Dorsal nerve root stimulation is an effective long-term treatment for neuropathic groin pain.
慢性神经性腹股沟疼痛是一个常见问题。它可在手术或创伤后出现，或作为各种盆腔疼痛综合征的一部分自发产生。文献中报道了多种不同的刺激技术来治疗该区域，但由于该区域解剖结构复杂，难以有效地以感觉异常为靶点。
在本研究中，我们报告了使用脊髓刺激和背根神经刺激治疗慢性神经性腹股沟、盆腔和腹部疼痛患者的结果。
开放标签的前瞻性研究，纳入了2011年7月1日至2013年10月31日在单一中心接受新型试验刺激器系统治疗的所有患者。
加拿大的学术性大学神经外科疼痛中心。
32例患者在胸段或腰段脊柱进行了脊髓刺激和/或背根神经刺激试验。通过视觉模拟量表疼痛评分、SF-36和吗啡等效日剂量对患者进行评估。在植入前访视以及永久植入后3个月、6个月和12个月记录数据。
15例接受永久植入的患者在12个月随访时平均疼痛显著减轻，生活质量得到改善。初始评估时服用阿片类药物的大多数患者能够通过治疗减少剂量。3例试验成功的患者为长期无反应者，其中2例移除了永久装置。
本研究若有更大样本量将更有益，这样就有足够的效力对患者亚组和刺激技术进行比较。
背根神经刺激是治疗神经性腹股沟疼痛的一种有效的长期治疗方法。
