Goudman Lisa, De Smedt Ann, Forget Patrice, Eldabe Sam, Moens Maarten
Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.
Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium.
Neuromodulation. 2021 Apr;24(3):520-531. doi: 10.1111/ner.13363. Epub 2021 Jan 20.
High-dose spinal cord stimulation (HD-SCS) revealed positive results for obtaining pain relief in patients with failed back surgery syndrome (FBSS). However, it is less clear whether HD-SCS also is able to reduce pain medication use. The aim of this registry-based cohort study is to explore the impact of HD-SCS on pain medication use in FBSS patients.
Data from the Discover registry was used in which the effectiveness of HD-SCS was explored in neurostimulation-naïve FBSS patients as well as in rescue patients. All neurostimulation-naïve FBSS patients positively responded to a four-week SCS trial period in which at least 50% pain relief and 50% medication reduction were obtained. Medication use was measured with the Medication Quantification Scale III (MQS) in 259 patients at baseline and at 1, 3, and 12 months of HD-SCS. Additionally, defined daily doses (DDD) and morphine milligram equivalents (MME) were calculated as well.
One hundred thirty patients reached the visit at 12 months. In neurostimulation-naïve patients, a statistically significant decrease in MQS (χ = 62.92, p < 0.001), DDD (χ = 11.47, p = 0.009), and MME (χ = 21.55, p < 0.001) was found. In rescue patients, no statistically significant improvements were found. In both patient groups, statistically significant reductions in the proportion of patients on high-risk MME doses ≥90 were found over time. At the intraindividual level, positive correlations were found between MSQ scores and pain intensity for back (r = 0.56, r = 0.31, p < 0.001) and leg pain (r = 0.61, r = 0.22, p < 0.001) in neurostimulation-naïve and rescue patients, respectively.
Registry data on HD-SCS in FBSS patients revealed a statistically significant and sustained decrease in pain medication use, not only on opioids, but also on anti-neuropathic agents in neurostimulation-naïve patients, who positively responded to an SCS trial period with at least 50% pain relief and 50% pain medication decrease, but not in rescue patients.
高剂量脊髓刺激（HD-SCS）在腰椎手术失败综合征（FBSS）患者的疼痛缓解方面显示出积极效果。然而，HD-SCS是否也能减少止痛药物的使用尚不清楚。这项基于注册登记的队列研究旨在探讨HD-SCS对FBSS患者止痛药物使用的影响。
使用来自Discover注册登记的数据，其中在未接受过神经刺激的FBSS患者以及补救患者中探讨了HD-SCS的有效性。所有未接受过神经刺激的FBSS患者对为期四周的SCS试验期均有积极反应，在此期间至少实现了50%的疼痛缓解和50%的药物减少。在259例患者的基线以及HD-SCS治疗后的1、3和12个月，使用药物量化量表III（MQS）测量药物使用情况。此外，还计算了限定日剂量（DDD）和吗啡毫克当量（MME）。
130例患者完成了12个月的随访。在未接受过神经刺激的患者中，发现MQS（χ = 62.92，p < 0.001）、DDD（χ = 11.47，p = 0.009）和MME（χ = 21.55，p < 0.001）有统计学显著下降。在补救患者中，未发现统计学显著改善。在两个患者组中，随着时间推移，高风险MME剂量≥90的患者比例均有统计学显著下降。在个体水平上，未接受过神经刺激的患者和补救患者的MSQ评分与背部疼痛强度（r = 0.56，r = 0.31，p < 0.001）和腿部疼痛强度（r = 0.61，r = 0.22，p < 0.001）之间分别存在正相关。
FBSS患者中关于HD-SCS的注册登记数据显示，在对SCS试验期有积极反应且至少实现了50%疼痛缓解和50%止痛药物减少的未接受过神经刺激的患者中，止痛药物使用有统计学显著且持续的下降，不仅是阿片类药物，抗神经病理性药物的使用也下降，但在补救患者中未出现这种情况。
