Neurosurgical Associates of Lancaster, Lancaster, PA, USA.
Pacific Sports and Interventional Spine, Eugene, OR, USA.
Neuromodulation. 2021 Apr;24(3):581-590. doi: 10.1111/ner.13226. Epub 2020 Jun 25.
Burst spinal cord stimulation (B-SCS) has been shown to reduce neuronal firing in the anterior cingulate cortex through selective modulation of the medial pain pathway tract. This pain pathway communicates the affective component of pain processing. The purpose of this study was to assess the effect of B-SCS on psychosocial functioning and its influence on pain and quality of life.
Eligible patients with chronic, intractable pain of the trunk, and/or lower limbs were enrolled. After a successful trial period, subjects received a permanent implant and returned for follow-up at 6- and 12-months.
In total, 269 patients were enrolled at 22 centers. Trial success rate was 90%. Significant improvements in pain, physical, mental, and emotional functioning were observed from baseline to the 6- and 12-month follow-up (p < 0.001). Overall, patients had improved quality of life, became more active, and the negative impact of pain on daily life was decreasing. At one year, 81% of subjects were satisfied or very satisfied with their therapy. Subjects showing significant improvements on mental health outcomes reported enhanced pain relief and quality of life scores compared with subjects with continued impaired mental health at follow-up. At one year, 89% of subjects who were taking opioids at baseline decreased or stayed at the same level of opioid use; 19% stopped taking any opioids. No unanticipated adverse events have been reported.
One-year outcomes after B-SCS show improvements across all evaluated psychological measures with the largest impact observed on catastrophizing and depression (the affective component of pain processing). These pain-related beliefs and behaviors, and not pain intensity, have been shown to put patients at greatest risk of a poor prognosis and quality of life.
通过选择性调节内侧疼痛通路，爆发性脊髓刺激（B-SCS）已被证明可以减少前扣带皮层的神经元放电。该疼痛通路传递疼痛处理的情感成分。本研究的目的是评估 B-SCS 对社会心理功能的影响及其对疼痛和生活质量的影响。
纳入患有躯干和/或下肢慢性、难治性疼痛的合格患者。在成功的试验期后，受试者接受了永久性植入物，并在 6 个月和 12 个月时进行随访。
共有 269 名患者在 22 个中心入组。试验成功率为 90%。从基线到 6 个月和 12 个月随访，疼痛、身体、心理和情绪功能均显著改善（p<0.001）。总体而言，患者的生活质量得到改善，变得更加活跃，疼痛对日常生活的负面影响正在减少。一年后，81%的患者对他们的治疗感到满意或非常满意。与随访时心理健康持续受损的患者相比，心理健康结果显著改善的患者报告说疼痛缓解和生活质量评分得到了提高。一年后，89%的基线时服用阿片类药物的患者减少或保持相同的阿片类药物使用水平；19%的患者停止服用任何阿片类药物。未报告任何意外不良事件。
B-SCS 一年后的结果显示，所有评估的心理测量指标均有所改善，其中对灾难化和抑郁（疼痛处理的情感成分）的影响最大。这些与疼痛相关的信念和行为，而不是疼痛强度，已被证明使患者面临最差预后和生活质量的风险最大。
