Department of Anesthesiology, New York Presbyterian Hospital, New York, NY, USA.
Pain Medicine Associates, Johnson City, TN, USA.
Neuromodulation. 2020 Aug;23(6):819-826. doi: 10.1111/ner.13139. Epub 2020 Mar 17.
Temporary, percutaneous peripheral nerve stimulation (PNS) has been shown to provide analgesia for acute postoperative pain, postamputation pain, and low back pain. The implanted device stimulates the neural target for up to 60 days at which point the leads are extracted. Patients have demonstrated prolonged analgesia continuing after extraction of the leads. The purpose of this case series is to demonstrate peripheral neural targets that could feasibly be used to treat various pain syndromes prevalent in the oncologic population.
A temporary, percutaneous PNS was implanted under ultrasound guidance in 12 oncologic chronic pain patients seen in an outpatient pain clinic who had failed medical and/or interventional management. The device was implanted for up to 60 days. Clinical progress of pain and functional capacity was monitored through regular clinical visits.
The case series presents seven successful cases of implementation of the PNS to treat oncologic pain. Three of these cases demonstrate targeting of proximal spinal nerves to treat truncal neuropathic pain and lumbar radicular pain. The four remaining cases demonstrate successful targeting of other peripheral nerves and brachial plexus. We also share five failed cases without adequate pain relief with PNS.
PNS has potential uses in the treatment of oncologic pain. Further high-quality studies should be designed to further elucidate use of the PNS to treat oncologic pain.
暂时的经皮外周神经刺激（PNS）已被证明可用于治疗急性术后疼痛、截肢后疼痛和腰痛。植入的设备可刺激神经靶标长达 60 天，此时将取出引线。患者在取出引线后仍表现出持续的镇痛作用。本病例系列的目的是展示外周神经靶标，这些靶标可能可用于治疗肿瘤患者中常见的各种疼痛综合征。
在门诊疼痛诊所就诊的 12 名患有慢性疼痛的肿瘤患者中，在超声引导下植入了临时经皮 PNS，这些患者在接受药物和/或介入治疗后均未得到缓解。该设备的植入时间最长可达 60 天。通过定期临床访视监测疼痛和功能能力的临床进展。
该病例系列报告了 7 例成功实施 PNS 治疗肿瘤疼痛的病例。其中 3 例成功靶向脊柱近端神经以治疗躯干神经性疼痛和腰椎神经根性疼痛。其余 4 例则成功靶向其他外周神经和臂丛神经。我们还分享了 5 例 PNS 治疗无效的失败病例。
PNS 在治疗肿瘤疼痛方面具有潜在的用途。应设计进一步的高质量研究来进一步阐明 PNS 治疗肿瘤疼痛的用途。
