Maino Paolo, Koetsier Eva, Kaelin-Lang Alain, Gobbi Claudio, Perez Roberto
Ospedale Regionale di Lugano, Viganello, Switzerland.
Department of Anesthesiology, VU University Medical Center, Amsterdam; Trauma Related Neuronal Dysfunction (TREND), Delft; EMGO+ Institute for Health and Care Research, Amsterdam.
Pain Physician. 2017 Mar;20(3):E459-E463.
Small fiber neuropathy is a disorder of the peripheral nerves with typical symptoms of burning, sharp, and shooting pain and sensory disturbances in the feet. Pain treatment depends principally on the underlying etiology with concurrent administration of antidepressants, anticonvulsants, opioids, and topical treatments like capsaicin and local anesthetics. However, treatments for pain relief in these patients frequently fail. We describe the first case of intractable painful small fiber neuropathy of the foot successfully treated with spinal cord stimulation of the left L5 dorsal root ganglion.A 74-year-old man presented at our clinic with severe intractable pain, dysesthesia, and allodynia of the left foot caused by idiopathic small fiber neuropathy, confirmed by skin biopsy. His pain score was 8 on a standard 0 - 10 numeric rating scale. As the pain was not satisfactorily controlled by conventional therapy, dorsal root ganglion stimulation was proposed to the patient and, after informed consent, a specifically designed percutaneous stimulation lead was placed over the left L5 dorsal root ganglion and connected to an external neurostimulator. After a positive trial of 10 days, a permanent neurostimulator was implanted. Twenty months post-implantation the patient continued to experience stimulation-induced paresthesia covering the entire pain area and reported a pain rating of 4.Results from the case report demonstrate that the dorsal root ganglion is a promising neural stimulation target to treat neuropathic pain due to intractable small fiber neuropathy. Prospective controlled studies are warranted to confirm the efficacy of this treatment as an option for the aforementioned condition.Key words: Dorsal root ganglion stimulation, small fiber neuropathy, neuropathic pain.
小纤维神经病变是一种周围神经疾病，具有典型症状，如灼痛、刺痛和射痛，以及足部感觉障碍。疼痛治疗主要取决于潜在病因，同时使用抗抑郁药、抗惊厥药、阿片类药物以及辣椒素和局部麻醉剂等局部治疗方法。然而，这些患者的疼痛缓解治疗常常失败。我们描述了首例通过刺激左侧L5背根神经节成功治疗顽固性足部疼痛性小纤维神经病变的病例。一名74岁男性因特发性小纤维神经病变就诊于我们的诊所，皮肤活检确诊，其左脚有严重的顽固性疼痛、感觉异常和痛觉过敏。在标准的0 - 10数字评分量表上，他的疼痛评分为8分。由于常规治疗无法令人满意地控制疼痛，我们向患者提议进行背根神经节刺激治疗，在获得知情同意后，将专门设计的经皮刺激电极放置在左侧L5背根神经节上方，并连接到外部神经刺激器。经过10天的阳性试验后，植入了永久性神经刺激器。植入后20个月，患者仍持续经历刺激诱发的感觉异常，覆盖整个疼痛区域，报告疼痛评分为4分。该病例报告结果表明，背根神经节是治疗顽固性小纤维神经病变所致神经病理性疼痛的一个有前景的神经刺激靶点。需要进行前瞻性对照研究以证实这种治疗方法对上述疾病的有效性。关键词：背根神经节刺激；小纤维神经病变；神经病理性疼痛
