The Pain Management and Neuromodulation Centre, Guy's and St. Thomas' Hospital, London, UK.
Multidisciplinary Pain Centre, AZ Nikolaas, St Niklaas, Belgium.
Sci Rep. 2019 Aug 7;9(1):11441. doi: 10.1038/s41598-019-47792-3.
Chronic pain, including chronic low back and leg pain are prominent causes of disability worldwide. While patient management aims to reduce pain and improve daily function, prescription of opioids remains widespread despite significant adverse effects. This study pooled data from two large prospective trials on 10 kHz spinal cord stimulation (10 kHz SCS) in subjects with chronic low back pain and/or leg pain and performed post hoc analysis on changes in opioid dosage 12 months post 10 kHz SCS treatment. Patient-reported back and leg pain using the visual analog scale (VAS) and opioid dose (milligrams morphine equivalent/day, MME/day) were compared at 12 months post-10 kHz SCS therapy to baseline. Results showed that in the combined dataset, 39.3% of subjects were taking >90 MME dose of opioids at baseline compared to 23.0% at 12 months post-10 kHz SCS therapy (p = 0.007). The average dose of opioids in >90 MME group was significantly reduced by 46% following 10 kHz SCS therapy (p < 0.001), which was paralleled by significant pain relief (P < 0.001). In conclusion, current analysis demonstrates the benefits of 10 kHz SCS therapy and offers an evidence-based, non-pharmaceutical alternative to opioid therapy and/or an adjunctive therapy to facilitate opioid dose reduction whilst delivering significant pain relief. Healthcare providers involved in management of chronic non-cancer pain can include reduction or elimination of opioid use as part of treatment plan when contemplating 10 kHz SCS.
慢性疼痛，包括慢性下腰痛和下肢痛，是全球范围内导致残疾的主要原因。尽管阿片类药物存在显著的不良反应，但患者管理的目标仍然是减轻疼痛和改善日常功能，因此阿片类药物的处方仍然广泛。本研究对两项关于 10kHz 脊髓刺激（10kHz SCS）治疗慢性下腰痛和/或下肢痛的大型前瞻性试验的数据进行了汇总，并对 10kHz SCS 治疗 12 个月后阿片类药物剂量的变化进行了事后分析。在 10kHz SCS 治疗 12 个月后，使用视觉模拟量表（VAS）评估患者的腰背和下肢疼痛，并与基线时的阿片类药物剂量（吗啡等效剂量/天，MME/天）进行比较。结果显示，在合并数据集的患者中，39.3%的患者在基线时服用>90MME 剂量的阿片类药物，而在 10kHz SCS 治疗 12 个月后，这一比例为 23.0%（p=0.007）。在 10kHz SCS 治疗后，>90MME 组的阿片类药物平均剂量显著减少 46%（p<0.001），同时疼痛也显著缓解（p<0.001）。综上所述，目前的分析表明 10kHz SCS 治疗具有显著疗效，为阿片类药物治疗提供了一种基于证据的非药物替代疗法，或者作为减少阿片类药物剂量的辅助疗法，同时提供显著的疼痛缓解。在考虑使用 10kHz SCS 治疗慢性非癌性疼痛时，参与疼痛管理的医疗服务提供者可以将减少或消除阿片类药物的使用纳入治疗方案。
