背根神经节刺激（DRGS）治疗慢性神经性疼痛：62 例单中心长期前瞻性研究结果。

Dorsal Root Ganglion Stimulation (DRGS) for the Treatment of Chronic Neuropathic Pain: A Single-Center Study with Long-Term Prospective Results in 62 Cases.

机构信息

University of Tuebingen, University Hospital, Dept. of Neurosurgery, Tuebingen, Germany.

Clinic of Neurosurgery, University Hospital, University of Tuebingen, Tuebingen, Germany.

出版信息

Pain Physician. 2018 Jul;21(4):E377-E387.

PMID:30045604

Abstract

BACKGROUND

Dorsal root ganglion stimulation (DRGS) treats discrete, localized areas of neuropathic pain. But there are no long-term results available so far.

OBJECTIVES

We studied the long-term outcome of DRGS used in the treatment of chronic neuropathic pain.

STUDY DESIGN

A prospective, longitudinal single center investigation.

SETTING

Academic medical center in Germany.

METHODS

Patients (age >18 years) with chronic neuropathic pain in the hands, back, legs, knees and feet were prospectively examined. After a successful test-trial (duration of 3-14 days, pain decrease > 50%), a permanent generator was implanted. The patients were re-examined after 1 year, 2 years and 3 years. We used the Visual Analogue Scale (VAS), the Pain Disability Index (PDI), the Pain Catastrophizing Scale (PCS), the Brief Pain Inventory (BPI), and, the Beck Depression Inventory (BDI) for our assessments.

RESULTS

We included 62 consecutive patients (27 females, 35 males, mean age 56.8 years, with an age range from 28 to 82 years, 62/51 to permanent conversion) during the time period from March 2012 until March 2016. Fifty-one patients had a successful test-trial and a generator was implanted subsequently. Results after 3 years: the VAS dropped from Mdn = 8 to Mdn = 4 (P = 0.0001). The PDI decreased from Mdn = 45 to Mdn = 23 (P = 0.003). The PCS decreased from Mdn = 34 to Mdn = 21 (P = 0.001). The BPI dropped from Mdn = 73 to Mdn = 30 (P = 0.003). The BDI decreased from Mdn = 36 to Mdn = 21 (P = 0.010). Fourteen patients showed complications (27.4%).

LIMITATIONS

This study is limited by the small number of patients in the single groups of the different pain locations.

CONCLUSION

DRGS may be an effective long-term method of treating discrete, localized areas of chronic neuropathic pain. We would recommend DRGS for the treatment of chronic neuropathic pain in such areas.

KEY WORDS

Knee pain, foot pain, hand pain, groin pain, neuromodulation, dorsal root ganglion stimulation, chronic neuropathic pain, paresthesia mapping.

摘要

背景

背根神经节刺激（DRGS）可治疗离散的局部神经性疼痛。但目前尚无长期结果。

目的

我们研究了 DRGS 治疗慢性神经性疼痛的长期效果。

研究设计

前瞻性、纵向单中心研究。

地点

德国学术医学中心。

方法

对患有手部、背部、腿部、膝盖和脚部慢性神经性疼痛的患者（年龄>18 岁）进行前瞻性检查。在成功的测试试验（持续 3-14 天，疼痛减轻>50%）后，植入永久性发生器。患者在 1 年、2 年和 3 年后再次接受检查。我们使用视觉模拟量表（VAS）、疼痛残疾指数（PDI）、疼痛灾难化量表（PCS）、简明疼痛量表（BPI）和贝克抑郁量表（BDI）进行评估。

结果

在 2012 年 3 月至 2016 年 3 月期间，我们共纳入 62 例连续患者（27 例女性，35 例男性，平均年龄 56.8 岁，年龄范围为 28-82 岁，62/51 转为永久性治疗）。51 例患者成功进行了测试试验，随后植入了发生器。3 年后的结果：VAS 从 Mdn=8 降至 Mdn=4（P=0.0001）。PDI 从 Mdn=45 降至 Mdn=23（P=0.003）。PCS 从 Mdn=34 降至 Mdn=21（P=0.001）。BPI 从 Mdn=73 降至 Mdn=30（P=0.003）。BDI 从 Mdn=36 降至 Mdn=21（P=0.010）。14 例患者出现并发症（27.4%）。