Department of Neurosurgery, Albany Medical College, Albany, New York.
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.
Neurosurgery. 2021 Mar 15;88(4):819-827. doi: 10.1093/neuros/nyaa537.
Secondary to the complex care, involved specialty providers, and various etiologies, chronic pelvic pain patients do not receive holistic care.
To compare our general and neuromodulation cohorts based on referrals, diagnosis, and therapy and describe our neuromodulation patients.
A multidisciplinary team was established at our center. The intake coordinator assessed demographics and facilitated care of enrolled patients. Outcomes were compared using minimal clinical important difference of current Numerical Rating Scale (NRS) between patients with neuropathic pain who received neuromodulation and those who did not. The neuromodulation cohort completed outcome metrics at baseline and recent follow-up, including NRS score (best, worst, and current), Oswestry Disability Index (ODI), Beck Depression Inventory, and Pain Catastrophizing Scale.
Over 7 yr, 233 patients were referred to our consortium and 153 were enrolled. A total of 55 patients had neuropathic pain and 44 of those were managed medically. Eleven underwent neuromodulation. A total of 45.5% patients of the neuromodulation cohort were classified as responders by minimal clinically important difference compared to 26.6% responders in the control cohort at most recent follow-up (median 25 and 33 mo, respectively). Outcome measures revealed improvement in NRS at worst (P = .007) and best (P = .025), ODI (P = .014), and Pain Catastrophizing Scale Rumination (P = .043).
Eleven percent of patients were offered neuromodulation. There were more responders in the neuromodulation cohort than the conservatively managed neuropathic pain cohort. Neuromodulation patients showed significant improvement at 29 mo in NRS best and worst pain, disability, and rumination. We share our algorithm for patient management.
由于复杂的护理、涉及的专科医生和各种病因，慢性盆腔疼痛患者无法得到全面的护理。
根据转诊、诊断和治疗情况比较我们的普通和神经调节队列，并描述我们的神经调节患者。
在我们的中心成立了一个多学科团队。入组协调员评估人口统计学数据并为入组患者提供护理。使用当前数值评分量表（NRS）的最小临床重要差异比较接受神经调节和未接受神经调节的神经病理性疼痛患者的结果。神经调节队列在基线和最近的随访时完成了包括 NRS 评分（最佳、最差和当前）、Oswestry 残疾指数（ODI）、贝克抑郁量表和疼痛灾难化量表在内的结局指标。
在 7 年期间，共有 233 名患者被转诊到我们的联合会，其中 153 名患者入组。共有 55 名患者患有神经病理性疼痛，其中 44 名患者接受了药物治疗。11 名患者接受了神经调节。在最近的随访中，与对照组相比，神经调节队列中有 45.5%的患者被归类为最小临床重要差异的应答者，而对照组中有 26.6%的应答者（中位数分别为 25 和 33 个月）。结果测量显示，在最差（P = 0.007）和最佳（P = 0.025）、ODI（P = 0.014）和疼痛灾难化量表沉思（P = 0.043）方面，NRS 得到改善。
11%的患者接受了神经调节。在神经调节队列中，应答者的比例高于保守治疗的神经病理性疼痛队列。神经调节患者在 29 个月时在 NRS 最佳和最差疼痛、残疾和沉思方面显示出显著改善。我们分享了患者管理的算法。
