接受单侧L4背根神经节刺激治疗的慢性神经性疼痛患者的定量感觉表型分析
Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulation.
作者信息
Kinfe Thomas, von Willebrand Nico, Stadlbauer Andreas, Buchfelder Michael, Yearwood Thomas L, Muhammad Sajjad, Chaudhry Shafqat R, Gravius Sascha, Randau Thomas, Winder Klemens, Maihöfner Christian, Gravius Nadine, Magerl Walter
机构信息
Division of Functional Neurosurgery and Stereotaxy, Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
Department of Neurosurgery, Rheinische Friedrich-Wilhelms University, Bonn, Germany.
出版信息
J Transl Med. 2020 Oct 21;18(1):403. doi: 10.1186/s12967-020-02566-8.
BACKGROUND
In a previous study, we reported that selective dorsal root ganglion stimulation (DRG) at DRG level L4 promoted a favorable outcome for complex regional pain syndrome (CRPS) patients along with DRG-related changes of inflammatory biomarkers in blood and saliva. The impact on somatosensation is largely unknown. Herein, we assessed the quantitative sensory profile to quantify L4-DRG effects in CRPS patients.
METHODS
Twelve refractory CRPS patients (4 female; 8 male; mean age 69 ± 9 years) received standardized quantitative sensory testing (QST) protocol at baseline and after 3 months of unilateral L4-DRG assessing nociceptive and non-nociceptive thermal and mechanical sensitivity of the knee affected by CRPS and the contralateral non-painful knee area.
RESULTS
At baseline, CRPS subjects showed significantly increased thresholds for warmth, tactile and vibration detection (WDT, MDT and VDT) and exaggerated pain summation (WUR). After 3 months of unilateral L4-DRG all pain parameters exhibited trends towards normalization of sensitivity accumulating to a significant overall normalization for pain sensitivity (effect size: 0.91, p < 0.01), while with the one exception of WDT all non-nociceptive QST parameters remained unchanged. Overall change of non-nociceptive detection was negligible (effect size: 0.25, p > 0.40). Notably, reduction of pain summation (WUR) correlated significantly with pain reduction after 3 months of L4-DRG.
CONCLUSIONS
Selective L4-DRG lowered ongoing pain in CRPS patients and evoked significant normalization in the pain domain of the somatosensory profile. Thermoreception and mechanoreception remained unchanged. However, larger randomized, sham-controlled trials are highly warranted to shed more light on effects and mechanisms of dorsal root ganglion stimulation on quantitative sensory characteristics. The study protocol was registered at the 15.11.2016 on German Register for Clinical Trials (DRKS ID 00011267). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011267.
背景
在之前的一项研究中，我们报告称，在L4节段的背根神经节（DRG）进行选择性刺激，可使复杂性区域疼痛综合征（CRPS）患者获得良好预后，同时血液和唾液中的炎症生物标志物也会出现与DRG相关的变化。而其对躯体感觉的影响在很大程度上尚不清楚。在此，我们评估了定量感觉概况，以量化L4-DRG对CRPS患者的影响。
方法
12例难治性CRPS患者（4例女性；8例男性；平均年龄69±9岁）在基线时以及单侧L4-DRG刺激3个月后接受了标准化的定量感觉测试（QST）方案，评估受CRPS影响的膝关节以及对侧无痛膝关节区域的伤害性和非伤害性热觉及机械觉敏感性。
结果
在基线时，CRPS患者的热觉、触觉和振动觉检测阈值（WDT、MDT和VDT）显著升高，疼痛总和（WUR）夸大。单侧L4-DRG刺激3个月后，所有疼痛参数均呈现出敏感性趋于正常化的趋势，累积至疼痛敏感性显著整体正常化（效应大小：0.91，p<0.01），而除WDT外，所有非伤害性QST参数均保持不变。非伤害性检测的总体变化可忽略不计（效应大小：0.25，p>0.40）。值得注意的是，L4-DRG刺激3个月后，疼痛总和（WUR）的降低与疼痛减轻显著相关。
结论
选择性L4-DRG降低了CRPS患者的持续性疼痛，并使躯体感觉概况的疼痛领域显著正常化。温度觉和机械觉保持不变。然而，非常有必要进行更大规模的随机、假手术对照试验，以更清楚地了解背根神经节刺激对定量感觉特征的影响和机制。该研究方案于2016年11月15日在德国临床试验注册中心注册（DRKS ID 00011267）。https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011267 。
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