Bouche Bénédicte, Manfiotto Marie, Rigoard Philippe, Lemarie Jean, Dix-Neuf Véronique, Lanteri-Minet Michel, Fontaine Denys
Pain Clinic, Clinique Saint Léonard Village Santé, Trélazé, France.
Department of Neurosurgery, CHU de Nice, Nice, France.
Neuromodulation. 2017 Oct;20(7):684-689. doi: 10.1111/ner.12573. Epub 2017 Feb 3.
We report the outcome of a consecutive series of 26 patients suffering from chronic medically-refractory neuropathic pain of the upper limb (including 16 patients with complex regional pain syndrome), topographically limited, treated by brachial plexus (BP) nerve roots or supra-scapular nerve (SSN) peripheral nerve stimulation (PNS).
The technique consisted in ultrasound-guided percutaneous implantation of a cylindrical lead (Pisces-Quad, Medtronic) close to the SSN or the cervical nerve roots within the BP, depending on the pain topography. All the patients underwent a positive trial stimulation before lead connection to a subcutaneous stimulator. Chronic bipolar stimulation mean parameters were: frequency 55.5 Hertz, voltage 1.17 Volts. The voltage was set below the threshold inducing muscle contractions or paresthesias.
Two patients were lost immediately after surgery. At last follow-up (mean 27.5 months), the 20 patients still using the stimulation experienced a mean pain relief of 67.1%. Seventeen patients were improved ≥50%, including 12 improved ≥70%. In 11 patients with a follow-up >2 years, the mean pain relief was 68%. At last follow-up, respectively, six out of the nine (67%) patients treated by SSN stimulation and 10 out of 17 patients (59%) treated by BP stimulation were improved ≥50%. At last follow-up, 12 out of 20 patients still using the stimulation were very satisfied, six were satisfied, and two were poorly satisfied. Complications were: stimulation intolerance due to shock-like sensations (three cases), superficial infection (1), lead fractures (2), and migration (1).
In this pilot study, SSN or BP roots PNS provided a relatively safe, durable and effective option to control upper limb neuropathic pain.
我们报告了连续26例患有上肢慢性药物难治性神经性疼痛（包括16例复杂性区域疼痛综合征患者）且疼痛在局部受限的患者，接受臂丛神经（BP）神经根或肩胛上神经（SSN）周围神经刺激（PNS）治疗的结果。
该技术包括在超声引导下经皮将圆柱形电极（美敦力公司的双鱼座四极电极）植入靠近SSN或BP内的颈神经根处，具体取决于疼痛部位。所有患者在将电极连接到皮下刺激器之前均进行了阳性试验刺激。慢性双极刺激的平均参数为：频率55.5赫兹，电压1.17伏。电压设置低于诱发肌肉收缩或感觉异常的阈值。
两名患者术后立即失访。在最后一次随访时（平均27.5个月），仍在使用刺激治疗的20例患者平均疼痛缓解率为67.1%。17例患者改善≥50%，其中12例改善≥70%。在11例随访时间>2年的患者中，平均疼痛缓解率为68%。在最后一次随访时，接受SSN刺激治疗的9例患者中有6例（67%）改善≥50%，接受BP刺激治疗的17例患者中有10例（59%）改善≥50%。在最后一次随访时，仍在使用刺激治疗的20例患者中，12例非常满意，6例满意，2例不满意。并发症包括：因电击样感觉导致的刺激不耐受（3例）、浅表感染（1例）、电极断裂（2例）和移位（1例）。
在这项初步研究中，SSN或BP神经根PNS为控制上肢神经性疼痛提供了一种相对安全、持久且有效的选择。
