Kapural Leonardo, Gilmore Christopher A, Chae John, Rauck Richard L, Cohen Steven P, Saulino Michael F, Wongsarnpigoon Amorn, McGee Meredith J, Boggs Joseph W
Center for Clinical Research and Carolina's Pain Institute, Winston Salem, North Carolina, U.S.A.
Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina, U.S.A.
Pain Pract. 2018 Jan;18(1):94-103. doi: 10.1111/papr.12571. Epub 2017 Apr 13.
As the leading cause of disability among U.S. adults, chronic low back pain (LBP) is one of the most prevalent and challenging musculoskeletal conditions. Neuromodulation provides an opportunity to reduce or eliminate the use of opioids to treat chronic LBP, but the cost and invasiveness of existing methods have limited its broad adoption, especially earlier in the treatment continuum. The present case report details the results of a novel method of short-term percutaneous peripheral nerve stimulation (PNS) in 2 subjects with chronic LBP. At the end of the 1-month therapy, stimulation was discontinued and the leads were withdrawn. PNS produced clinically significant improvements in pain (62% average reduction in Brief Pain Inventory Question #5, average pain), and functional outcomes (73% reduction in disability, Oswestry Disability Index; 83% reduction in pain interference, Brief Pain Inventory). Both subjects reduced nonopioid analgesic use by 83%, on average, and the one subject taking opioids ceased using all opioids. The only adverse event was minor skin irritation caused by a topical dressing. The clinically significant improvements were sustained at least 4 months after start of therapy (79% average reduction in pain; both reported minimal disability; 100% reduction in opioids; 74% reduction nonopioids). The results reveal the utility of this novel, short-term approach and its potential as a minimally invasive neuromodulation therapy for use earlier in the treatment continuum to produce sustained pain relief and reduce or eliminate the need for analgesic medications, including opioids, as well as more expensive and invasive surgical or therapeutic alternatives.
作为美国成年人残疾的主要原因，慢性下腰痛（LBP）是最普遍且最具挑战性的肌肉骨骼疾病之一。神经调节为减少或消除使用阿片类药物治疗慢性LBP提供了机会，但现有方法的成本和侵入性限制了其广泛应用，尤其是在治疗过程的早期阶段。本病例报告详细介绍了一种新型短期经皮外周神经刺激（PNS）方法在2例慢性LBP患者中的应用结果。在1个月的治疗结束时，停止刺激并拔除电极。PNS在疼痛（简明疼痛问卷第5题平均疼痛评分平均降低62%）和功能结局（Oswestry功能障碍指数残疾程度降低73%；简明疼痛问卷疼痛干扰程度降低83%）方面产生了具有临床意义的改善。两名患者非阿片类镇痛药的使用平均减少了83%，且其中一名服用阿片类药物的患者停止使用了所有阿片类药物。唯一的不良事件是局部敷料引起的轻微皮肤刺激。治疗开始后至少4个月，临床显著改善得以维持（平均疼痛降低79%；两人均报告残疾程度轻微；阿片类药物使用减少100%；非阿片类药物使用减少74%）。结果揭示了这种新型短期方法的实用性及其作为一种微创神经调节疗法在治疗过程早期使用的潜力，以实现持续的疼痛缓解，并减少或消除对包括阿片类药物在内的镇痛药以及更昂贵且侵入性更强的手术或治疗替代方案的需求。
