Spine and Nerve Center of the Virginias, Charleston, West Virginia, USA.
Center for Clinical Research, Winston Salem, North Carolina, USA.
Pain Med. 2021 Mar 18;22(3):548-560. doi: 10.1093/pm/pnaa432.
Lumbar radiofrequency ablation is a commonly used intervention for chronic back pain. However, the pain typically returns, and though retreatment may be successful, the procedure involves destruction of the medial branch nerves, which denervates the multifidus. Repeated procedures typically have diminishing returns, which can lead to opioid use, surgery, or implantation of permanent neuromodulation systems. The objective of this report is to demonstrate the potential use of percutaneous peripheral nerve stimulation (PNS) as a minimally invasive, nondestructive, motor-sparing alternative to repeat radiofrequency ablation and more invasive surgical procedures.
Prospective, multicenter trial.
Individuals with a return of chronic axial pain after radiofrequency ablation underwent implantation of percutaneous PNS leads targeting the medial branch nerves. Stimulation was delivered for up to 60 days, after which the leads were removed. Participants were followed up to 5 months after the start of PNS. Outcomes included pain intensity, disability, and pain interference.
Highly clinically significant (≥50%) reductions in average pain intensity were reported by a majority of participants (67%, n = 10/15) after 2 months with PNS, and a majority experienced clinically significant improvements in functional outcomes, as measured by disability (87%, n = 13/15) and pain interference (80%, n = 12/15). Five months after PNS, 93% (n = 14/15) reported clinically meaningful improvement in one or more outcome measures, and a majority experienced clinically meaningful improvements in all three outcomes (i.e., pain intensity, disability, and pain interference).
Percutaneous PNS has the potential to shift the pain management paradigm by providing an effective, nondestructive, motor-sparing neuromodulation treatment.
腰椎射频消融术是治疗慢性背痛的常用方法。然而，疼痛通常会复发，尽管再次治疗可能有效，但该手术会破坏内侧支神经，使多裂肌失去神经支配。反复进行该手术效果会逐渐减弱，这可能导致需要使用阿片类药物、手术或植入永久性神经调节系统。本报告的目的是展示经皮外周神经刺激（PNS）作为一种微创、非破坏性、保留运动功能的替代方案，可替代重复射频消融和更具侵袭性的手术。
前瞻性、多中心试验。
接受射频消融治疗后慢性轴性疼痛复发的患者接受经皮 PNS 导丝植入，以靶向内侧支神经。刺激持续长达 60 天，然后取出导丝。参与者在开始 PNS 后随访 5 个月。结果包括疼痛强度、残疾和疼痛干扰。
大多数患者（67%，n=10/15）在接受 PNS 治疗 2 个月后报告平均疼痛强度有显著（≥50%）降低，大多数患者的残疾（87%，n=13/15）和疼痛干扰（80%，n=12/15）等功能结果也有显著改善。在 PNS 后 5 个月，93%（n=14/15）报告在一项或多项结果测量中有临床意义的改善，大多数患者在所有三个结果（即疼痛强度、残疾和疼痛干扰）中都有显著改善。
经皮 PNS 具有提供有效、非破坏性、保留运动功能的神经调节治疗的潜力，有可能改变疼痛管理模式。
