Eldabe Sam, Espinet Anthony, Wahlstedt Anders, Kang Porhan, Liem Liong, Patel Nikunj K, Vesper Jan, Kimber Alicia, Cusack William, Kramer Jeffery
Department of Pain, The James Cook University Hospital, Middlesbrough, UK.
The Pain Doctors, Benowa, QLD, Australia.
Neuromodulation. 2018 Dec;21(8):787-792. doi: 10.1111/ner.12767. Epub 2018 Mar 25.
The dorsal root ganglion (DRG) has been identified as an important neural structure in the development and maintenance of chronic pain. We present a retrospective case series of patients with refractory painful diabetic peripheral neuropathy (PDPN) that underwent electrical stimulation of the DRG and report on changes in their overall perceived pain and complication rates.
Ten diabetic males (mean age 65.2 [SD 8.8] years) with painful symptoms of the lower limbs were enrolled and trialed with up to four quadripolar percutaneous DRG stimulation leads between L2 and L5 spinal levels. Patients received a fully implantable neurostimulation system (Abbott Laboratories, Sunnyvale, CA, USA) immediately or after a successful trial period (>50% reduction in pain). Overall perceived pain was measured by visual analogue scale (VAS) at baseline, one-week postimplantation and one-, three-, six-, and twelve-month follow-up (n = 5).
Ten patients were included in this retrospective study. Seven of these subjects received permanent stimulator implants after successful externalized or intraoperative trials. Two of those patients subsequently required explantation, due to failure to capture primary pain area (n = 1) and personal reasons (n = 1). For the five subjects that proceeded to clinical follow-ups, baseline VAS was reduced by an average of 63.90% (SD 21.39; p < 0.001) postimplantation. For four patients with available 12-month follow-up data, mean relative reduction in overall perceived pain averaged 64.16% (SD 35.8; p< 0.001).
Early findings from this small retrospective case series, suggest DRG is a safe and effective neuromodulation modality to improve painful symptoms in PDPN patients. Future prospective trials are required to further investigate the use of DRG stimulation for this clinical indication.
背根神经节（DRG）已被确定为慢性疼痛发生和维持过程中的重要神经结构。我们报告了一组接受DRG电刺激治疗难治性疼痛性糖尿病周围神经病变（PDPN）患者的回顾性病例系列，并阐述了他们总体疼痛感受和并发症发生率的变化情况。
纳入10名有下肢疼痛症状的男性糖尿病患者（平均年龄65.2岁[标准差8.8岁]），在L2至L5脊髓节段试用多达4根四极经皮DRG刺激电极。患者在成功的试验期（疼痛减轻>50%）后立即或之后接受完全植入式神经刺激系统（美国加利福尼亚州森尼韦尔市雅培实验室）。在基线、植入后1周以及1、3、6和12个月随访时（n = 5），通过视觉模拟量表（VAS）测量总体疼痛感受。
本回顾性研究纳入了10名患者。其中7名受试者在成功进行体外或术中试验后接受了永久性刺激器植入。其中2名患者随后因未能覆盖主要疼痛区域（n = 1）和个人原因（n = 1）而需要取出植入物。对于进行临床随访的5名受试者，植入后基线VAS平均降低了63.90%（标准差21.39；p < 0.001）。对于4名有12个月随访数据的患者，总体疼痛感受的平均相对降低率为64.16%（标准差35.8；p < 0.001）。
这个小型回顾性病例系列的早期结果表明，DRG是改善PDPN患者疼痛症状的一种安全有效的神经调节方式。未来需要进行前瞻性试验，以进一步研究DRG刺激在这一临床适应症中的应用。
