Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA.
Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
Neuromodulation. 2021 Jun;24(4):769-773. doi: 10.1111/ner.13144. Epub 2020 Mar 11.
Complex regional pain syndrome (CRPS) can be effectively treated with spinal cord stimulation (t-SCS). There is also evidence that dorsal root ganglion (DRG) stimulation may be superior to t-SCS in CRPS. However, there has been no published data, to our knowledge, that looked at the concurrent use of t-SCS and DRG stimulation for treatment of CRPS.
Our study includes four patients with severe CRPS who had all been implanted with a t-SCS. While all these patients had positive results from their t-SCS, they all had areas which lacked coverage, giving them incomplete pain relief. These patients also underwent successful trial and implantation of DRG-S. All four patients reported further improvement in their residual pain and function with DRG-S (>60%), and even superior pain relief (>80%) with concurrent use of t-SCS and t-SCS.
All patients had a diagnosis of lower extremity CRPS-1. After DRG-S implantation, multiple attempts were made in each patient to use DRG-S alone by temporarily turning the t-SCS off. However, in each attempt, all patients consistently reported superior pain relief and improvement in function with the concurrent use of t-SCS and DRG, as compared to DRG alone. The average numeric rating scale pain score decreased from approximately 7 in the regions not covered by t-SCS to 3 after DRG-S implantation, and to 1.25 with concurrent use t-SCS and DRG-S.
Both t-SCS and DRG-S have been shown to be effective in treatment of patients with CRPS. In our study, concurrent use of t-SCS and DRG-S provided significant improvement in pain and function as compared to using either device alone. This suggests the potential that combination therapy with t-SCS and DRG-S may be beneficial in patients with CRPS. Further prospective studies are required to evaluate this concept.
复杂区域疼痛综合征 (CRPS) 可以通过脊髓刺激 (t-SCS) 进行有效治疗。有证据表明，背根神经节 (DRG) 刺激在 CRPS 中的效果可能优于 t-SCS。然而，据我们所知，目前还没有发表的数据研究同时使用 t-SCS 和 DRG 刺激来治疗 CRPS。
我们的研究包括四名接受过 t-SCS 植入的严重 CRPS 患者。虽然所有这些患者的 t-SCS 都取得了积极的效果，但他们都有覆盖范围不足的区域，导致他们的疼痛缓解不完整。这些患者还成功地进行了 DRG-S 的试用和植入。所有四名患者都报告说，DRG-S 的使用进一步改善了他们的残余疼痛和功能（>60%），甚至在同时使用 t-SCS 和 t-SCS 时缓解了更严重的疼痛（>80%）。
所有患者均被诊断为下肢 CRPS-1。在植入 DRG-S 后，在每个患者中都多次尝试单独使用 DRG-S，暂时关闭 t-SCS。然而，在每次尝试中，与单独使用 DRG 相比，所有患者都一致报告说同时使用 t-SCS 和 DRG 可获得更好的疼痛缓解和功能改善。在植入 DRG-S 后，未被 t-SCS 覆盖的区域的数字评分量表疼痛评分从约 7 降低到 3，而同时使用 t-SCS 和 DRG-S 时则降低到 1.25。
t-SCS 和 DRG-S 都已被证明对治疗 CRPS 患者有效。在我们的研究中，与单独使用任何一种设备相比，同时使用 t-SCS 和 DRG-S 可显著改善疼痛和功能。这表明，t-SCS 和 DRG-S 的联合治疗可能对 CRPS 患者有益。需要进一步的前瞻性研究来评估这一概念。
