Nagpal Ameet, Clements Nathan, Duszynski Belinda, Boies Brian
Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Pain Med. 2021 Feb 4;22(1):49-59. doi: 10.1093/pm/pnaa369.
To evaluate the effectiveness of dorsal root ganglion neurostimulation for the treatment of refractory, focal pain in the pelvis and lower extremities.
Systematic review.
The primary outcome was ≥50% pain relief. Secondary outcomes were physical function, mood, quality of life, opioid usage, and complications.
One pragmatic randomized controlled trial, four prospective cohort studies, and eight case series met the inclusion criteria. A worst-case scenario analysis from the randomized controlled trial reported ≥50% pain relief in 74% of patients with dorsal root ganglion neurostimulation vs. 51% of patients who experienced at least 50% relief with spinal cord stimulation at 3 months. Cohort data success rates ranged from 43% to 83% at ≤6 months and 27% to 100% at >6 months. Significant improvements were also reported in the secondary outcomes assessed, including mood, quality of life, opioid usage, and health care utilization, though a lack of available quantitative data limits further statistical analysis. Complication rates vary, though the only randomized controlled trial reported a higher rate of adverse events than that seen with traditional neurostimulation.
In accordance with the Grades of Recommendation, Assessment, Development, and Evaluation system, low-quality evidence supports dorsal root ganglion neurostimulation as a more effective treatment than traditional neurostimulation for pain and dysfunction associated with complex regional pain syndrome or causalgia. Very low-quality evidence supports dorsal root ganglion neurostimulation for the treatment of chronic pelvic pain, chronic neuropathic groin pain, phantom limb pain, chronic neuropathic pain of the trunk and/or limbs, and diabetic neuropathy.
评估背根神经节神经刺激术治疗骨盆和下肢难治性局灶性疼痛的有效性。
系统评价。
主要观察指标为疼痛缓解≥50%。次要观察指标包括身体功能、情绪、生活质量、阿片类药物使用情况及并发症。
一项实用随机对照试验、四项前瞻性队列研究和八项病例系列研究符合纳入标准。随机对照试验的最坏情况分析报告，背根神经节神经刺激术治疗的患者中有74%疼痛缓解≥50%，而脊髓刺激术治疗的患者在3个月时疼痛缓解至少50%的比例为51%。队列数据的成功率在≤6个月时为43%至83%，在>6个月时为27%至100%。在评估的次要观察指标中也报告了显著改善，包括情绪、生活质量、阿片类药物使用情况和医疗保健利用率，尽管缺乏可用的定量数据限制了进一步的统计分析。并发症发生率各不相同，不过唯一的随机对照试验报告不良事件发生率高于传统神经刺激术。
根据推荐分级、评估、制定和评价系统，低质量证据支持背根神经节神经刺激术是一种比传统神经刺激术更有效的治疗方法，用于治疗与复杂性区域疼痛综合征或灼性神经痛相关的疼痛和功能障碍。极低质量证据支持背根神经节神经刺激术用于治疗慢性盆腔疼痛、慢性神经性腹股沟疼痛、幻肢痛、躯干和/或四肢慢性神经性疼痛以及糖尿病性神经病变。
