Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, U.S.A.
Pain Pract. 2021 Apr;21(4):411-418. doi: 10.1111/papr.12968. Epub 2020 Dec 10.
Peripheral nerve stimulation (PNS) is a rapidly expanding field within neuromodulation; however, there is limited data on therapeutic efficacy. This study describes the indications and clinical outcomes for patients undergoing PNS for chronic pain states.
This is a retrospective case series of adults undergoing PNS implantation from 2004 to 2017 at an academic medical center. The primary outcomes were changes in numeric rating scale (NRS) pain scores, opioid utilization in oral morphine milligram equivalent (MME), and self-reported patient functioning at 6 months postoperatively. Infectious and device-related complications were also assessed.
A total of 72 patients underwent PNS implantation, including 59 patients that received a preceding PNS trial (59/78; 76% progression rate) and 13 that did not receive a PNS trial. The most common indication for stimulation was occipital neuralgia (47%) followed by lower-extremity neuropathies (17%). PNS implantation was associated with 6-month reductions in pain scores (7 [6, 8] baseline vs. 4 [2, 5] 6 months; P < 0.001) and opioid utilization (eg, median 60 [31, 104] vs. 18 [0, 52] MME among those with baseline opioid use; P < 0.001). Median functional improvement was 73% (50%, 88%). Seven patients (10%) suffered a postoperative surgical site infection at a median of 50 (30, 124) days, of which five devices were removed.
Peripheral nerve stimulation was associated with reduced pain scores, lower opioid utilization, and improved patient function at 6 months. These data support PNS as a potentially effective nonopioid analgesic modality in chronic pain, though prospective multicenter evaluation is warranted to evaluate longer-term outcomes.
周围神经刺激（PNS）是神经调节领域中迅速发展的一个分支；然而，关于其治疗效果的数据有限。本研究描述了在学术医疗中心接受 PNS 治疗慢性疼痛患者的适应证和临床结果。
这是一项回顾性病例系列研究，纳入了 2004 年至 2017 年期间在学术医疗中心接受 PNS 植入的成年人。主要结局是数字评分量表（NRS）疼痛评分的变化、口服美沙酮毫克当量（MME）的阿片类药物使用情况以及术后 6 个月时患者自我报告的功能。还评估了感染和设备相关并发症。
共有 72 例患者接受了 PNS 植入，其中 59 例患者在植入前接受了 PNS 试验（59/78；76%的进展率），13 例患者未接受 PNS 试验。刺激最常见的适应证是枕神经痛（47%），其次是下肢神经病变（17%）。PNS 植入与 6 个月时疼痛评分的降低相关（7 [6, 8] 基线 vs. 4 [2, 5] 6 个月；P<0.001）和阿片类药物使用的减少（例如，基线使用阿片类药物的患者中中位数 60 [31, 104] vs. 18 [0, 52] MME；P<0.001）。中位数功能改善为 73%（50%，88%）。7 例患者（10%）在中位数 50（30, 124）天发生术后手术部位感染，其中 5 例设备被移除。
PNS 与疼痛评分降低、阿片类药物使用减少和 6 个月时患者功能改善相关。这些数据支持 PNS 作为慢性疼痛的一种潜在有效非阿片类镇痛方式，尽管需要前瞻性多中心评估以评估更长期的结果。
