Prabhala Tarun, Sabourin Shelby, DiMarzio Marisa, Gillogly Michael, Prusik Julia, Pilitsis Julie G
Department of Neurosurgery, Albany Medical College, Albany, New York, USA.
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA.
Neuromodulation. 2019 Feb;22(2):215-218. doi: 10.1111/ner.12872. Epub 2018 Oct 16.
Spinal cord stimulation (SCS) has been shown to be effective in treating chronic pain in patients with varying etiologies. However, the impact of pharmacological treatment on augmenting response to SCS has not been previously studied.
We enrolled 108 patients who had undergone SCS surgery and documented their pain preoperatively and at 12 months postoperatively using the Numeric Rating Scale (NRS), McGill Pain Questionnaire (MPQ), Beck Depression Inventory (BDI), Oswestry Disability Index (ODI), Pain Catastrophizing Scale (PCS), and Global Impression of Change (GIC). Pain outcomes were compared between patients receiving SCS alone and in addition to duloxetine.
At 1-year follow-up, patients receiving duloxetine and SCS (n = 41) had better pain relief in the affective component of MPQ (p < 0.05) than those receiving SCS alone (n = 71). Patients on duloxetine with SCS also were significantly more willing to receive SCS again (p < 0.01). This willingness appeared to be duloxetine dose dependent (p < 0.05). Patients receiving pregabalin or gabapentin with SCS did not have significantly more pain relief than patients receiving SCS alone.
This study shows the combination therapy to be an effective strategy to provide more holistic pain relief and further improve the quality of life of SCS patients.
脊髓刺激（SCS）已被证明在治疗病因各异的患者的慢性疼痛方面有效。然而，药物治疗对增强SCS反应的影响此前尚未得到研究。
我们招募了108例接受SCS手术的患者，并使用数字评分量表（NRS）、麦吉尔疼痛问卷（MPQ）、贝克抑郁量表（BDI）、奥斯维斯特里功能障碍指数（ODI）、疼痛灾难化量表（PCS）和总体变化印象（GIC）记录他们术前和术后12个月的疼痛情况。比较了单独接受SCS治疗的患者和同时接受度洛西汀与SCS治疗的患者的疼痛结果。
在1年的随访中，接受度洛西汀和SCS治疗的患者（n = 41）在MPQ情感成分方面的疼痛缓解情况（p < 0.05）优于单独接受SCS治疗的患者（n = 71）。接受度洛西汀联合SCS治疗的患者也明显更愿意再次接受SCS治疗（p < 0.01）。这种意愿似乎与度洛西汀剂量有关（p < 0.05）。接受普瑞巴林或加巴喷丁联合SCS治疗的患者与单独接受SCS治疗的患者相比，疼痛缓解情况没有显著差异。
本研究表明联合治疗是一种有效的策略，可提供更全面的疼痛缓解，并进一步改善SCS患者的生活质量。
