Vargovich Alison M, Chorney Jill, Gross Richard T, Vowles Kevin E
Department of Family Medicine, West Virginia University, Morgantown, WV, USA.
Department of Medicine, Division of Behavioral Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA.
Am J Case Rep. 2018 Nov 19;19:1373-1377. doi: 10.12659/AJCR.911157.
BACKGROUND Both spinal cord stimulators (SCS) and interdisciplinary chronic pain rehabilitation program (CPRP) are evidence-based treatments for chronic pain but differ on treatment foci. SCS focuses on decreasing the subjective pain experience as a means of improving function and quality of life. CPRP focuses on addressing the cognitive, emotional, and behavioral factors associated with chronic pain to improve function. Due to experimental constraints, these 2 treatment options are difficult to compare; however, this case report offers a unique opportunity to examine outcomes for both interventions in a sequential manner for changes in pain, function, and mood. CASE REPORT This single case study examined the separate and sequential outcomes of SCS and CPRP in a 26-year-old patient with a work-related injury resulting in chronic upper extremity pain. This patient was treated within an interdisciplinary CPRP following failure and removal of an SCS. Outcomes were measured by psychological assessments and return-to-work through a 6-month post-CPRP follow-up. CONCLUSIONS Pain intensity decreased following SCS placement and CPRP, while pain-related distress, pain interference, and overall affect improved only after CPRP, with sustained improvements at 6-month follow-up. Patient evidenced improvement following treatment with SCS and CPRP. SCS resulted in improvement in subjective pain and modest improved self-reported activity. CPRP demonstrated marked improvement in pain, self-reported function, and mood with patient eventually returning to work and maintaining most of these gains 6-months after completing CPRP treatment.
脊髓刺激器（SCS）和跨学科慢性疼痛康复计划（CPRP）都是基于证据的慢性疼痛治疗方法，但治疗重点有所不同。SCS专注于减轻主观疼痛体验，以此作为改善功能和生活质量的手段。CPRP则专注于解决与慢性疼痛相关的认知、情绪和行为因素，以改善功能。由于实验限制，这两种治疗方案难以比较；然而，本病例报告提供了一个独特的机会，可依次检查这两种干预措施在疼痛、功能和情绪变化方面的结果。
本单病例研究考察了一名26岁因工伤导致慢性上肢疼痛患者接受SCS和CPRP单独及先后治疗的结果。该患者在SCS治疗失败并移除后，接受了跨学科CPRP治疗。通过心理评估和CPRP治疗后6个月的复工情况来衡量结果。
SCS植入和CPRP治疗后疼痛强度降低，而与疼痛相关的痛苦、疼痛干扰和总体情绪仅在CPRP治疗后得到改善，在6个月随访时仍持续改善。患者在接受SCS和CPRP治疗后有改善。SCS使主观疼痛得到改善，自我报告的活动也有适度改善。CPRP在疼痛、自我报告的功能和情绪方面有显著改善，患者最终复工，并在完成CPRP治疗6个月后维持了大部分改善成果。
