Owusu Stephanie, Huynh Alexander, Gruenthal Eric, Prusik Julia, Owusu-Sarpong Stephane, Cherala Rasan, Peng Sophia, Pilitsis Julie G, McCallum Sarah E
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.
Neuromodulation. 2017 Aug;20(6):567-574. doi: 10.1111/ner.12633. Epub 2017 Jul 11.
Spinal cord stimulation (SCS) is an efficacious therapy used to treat chronic pain. The type of SCS programming is important in improving patients' quality of life and overall satisfaction. In this study, 19 patients who underwent SCS with traditional devices were given between 4 and 6 programs including programs with stimulation below sensory threshold and above sensory threshold. Usage patterns and preferences were assessed.
SCS patients were given 4-6 programs, some above sensory threshold and some below threshold immediately postoperatively after permanent implantation. Usage patterns of different programs were documented, including percent of time that the settings were used and preference for above threshold vs. below threshold settings during sleeping, walking, sitting, and vigorous activity. Improvements at three months in Oswestry disability index (ODI), numeric rating scale (NRS), Beck depression inventory (BDI), McGill pain questionnaire (MPQ), pain catastrophizing scale (PCS), insomnia severity index (ISI), and Epworth sleepiness scale (ESS) were evaluated.
Patients were all trialed on above sensory threshold programs. Six weeks after implantation, most patients preferred above threshold stimulation (74%) vs. below threshold waveforms (21%). Patient diagnosis, type/location of lead or recharging burden played no role in patient preference. Above threshold patients had significantly better improvement in BDI scores than did below threshold patients (p < 0.05) at three-month follow-up but also had worse ESS scores (p < 0.05). Above threshold stimulation was preferred for walking and sitting (p < 0.05).
Results indicate that when given the option between waveforms inducing paresthesias and those that do not, SCS patients tend to prefer waveforms that induce paresthesias. Among users of above threshold waveforms, there was preference for these settings during walking and sitting. There was a trend for below threshold preference in vigorous activity and sleeping.
脊髓刺激（SCS）是一种用于治疗慢性疼痛的有效疗法。SCS编程类型对于改善患者生活质量和总体满意度至关重要。在本研究中，19例接受传统设备SCS治疗的患者被给予4至6种程序，包括感觉阈值以下和以上的刺激程序。评估了使用模式和偏好。
SCS患者在永久植入后立即被给予4 - 6种程序，一些在感觉阈值以上，一些在阈值以下。记录不同程序的使用模式，包括设置使用的时间百分比以及在睡眠、行走、坐着和剧烈活动期间对阈值以上与阈值以下设置的偏好。评估三个月时Oswestry功能障碍指数（ODI）、数字评分量表（NRS）、贝克抑郁量表（BDI）、麦吉尔疼痛问卷（MPQ）、疼痛灾难化量表（PCS）、失眠严重程度指数（ISI）和爱泼华嗜睡量表（ESS）的改善情况。
所有患者均试用了感觉阈值以上的程序。植入后六周，大多数患者更喜欢阈值以上的刺激（74%），而不是阈值以下的波形（21%）。患者诊断、导联类型/位置或充电负担对患者偏好没有影响。在三个月的随访中，阈值以上的患者BDI评分改善明显优于阈值以下的患者（p < 0.05），但ESS评分更差（p < 0.05）。行走和坐着时更喜欢阈值以上的刺激（p < 0.05）。
结果表明，当在诱发感觉异常的波形和不诱发感觉异常的波形之间进行选择时，SCS患者倾向于更喜欢诱发感觉异常的波形。在阈值以上波形的使用者中，行走和坐着时更喜欢这些设置。在剧烈活动和睡眠中，有倾向于选择阈值以下的偏好。
