Esin R G, Danilov V I, Khairullin I Kh, Esin O R, Sakhapova L R
Kazan State Medical Academy, Kazan, Russia.
Kazan (Volga region) Federal University, Kazan, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(3):64-69. doi: 10.17116/jnevro202112103164.
To study a role of central sensitization (CS) in patients with Failed Back Surgery Syndrome (FBSS) after decompression of the lumbar and/or sacral roots.
The study included three groups of patients: 1) early FBSS (e-FBSS, =23), pain after surgery decreased, but continued to significantly bother the patient, or recurred in the first 6 months after surgery; 2) middle FBSS (m-FBSS, =42), pain after surgery completely stopped, but recurred within 6-12 months; 3) late FBSS (l-FBSS, =31), if pain relapse occurred more than 12 months later. Neurological status assessment, study of muscle trigger zones (MTZ), postoperative scar trigger zones (TZS), pain assessment according to the Visual Analogue Scale (VAS), CS assessment according to the Russian version of the Central Sensitization Inventory (CSI) were performed. Treatment included the following stages: stage 1 (non-steroidal anti-inflammatory drug (NSAID) meloxicam 15 mg 7 days); stage 2 (aminophenylbutyric acid hydrochloride (APAH) 250 mg 3 times a day 14 days); stage 3 (fluvoxamine 50 mg daily 8 weeks); stage 4 (MTZ and TZS treatment, fitness program). In addition to the previously described 96 patients, 15 patients (4 men and 11 women, aged 36-47 years) with FBSS and widespread pain, corresponding to the criteria for fibromyalgia ACTTION-APS Pain Taxonomy, who took only milnacipran 25-50 mg daily for two months (WSP-FBSS group), were studied.
At baseline, CSI and VAS are as follows: CSI=72.2±6.5; VAS=58.5±8.8 in the e-FBSS group; CSI=49.2±9.0; VAS=39.5±5.3 in the m-FBSS group; CSI=18.1±5.9; VAS=18.1±5.4 in the l-FBSS group. All patients have active MTZ and TZS. The differences between MTZ and TZS subgroups were in the reproduction of pain - the appearance of pain characteristic of the patient during stimulation (pressure) of the MTZ or TZS. In the e-FBSS group, there is the low efficacy of NSAIDs, the moderate efficacy of APAH, the high efficacy of fluvoxamine. In the m-FBSS group, the moderate efficacy of NSAIDs and APAH and the high efficacy of fluvoxamine are observed. In the l-FBSS group, there is the high efficacy of NSAIDs. In the WSP-FBSS group, VAS and CSI are 58.8±9.2 mm and 75.1±8.04, respectively, before treatment, 15.51±5.1 mm (=0.00032) and 25.6±8.2 (=0.0002), respectively, after 2 months of treatment.
In patients with FBSS, MTZ and TZS should be treated taking into account CS. The study shows the efficacy of APAH, fluvoxamine and milnacipran in the presence of CS.
研究中枢敏化（CS）在腰骶神经根减压术后腰椎手术失败综合征（FBSS）患者中的作用。
该研究纳入三组患者：1）早期FBSS（e-FBSS，n = 23），术后疼痛减轻，但仍持续严重困扰患者，或在术后前6个月复发；2）中期FBSS（m-FBSS，n = 42），术后疼痛完全消失，但在6 - 12个月内复发；3）晚期FBSS（l-FBSS，n = 31），若疼痛复发发生在12个月以后。进行神经学状态评估、肌肉触发点（MTZ）研究、术后瘢痕触发区（TZS）研究、根据视觉模拟量表（VAS）进行疼痛评估、根据俄罗斯版中枢敏化量表（CSI）进行CS评估。治疗包括以下阶段：第1阶段（非甾体抗炎药美洛昔康15 mg，7天）；第2阶段（盐酸氨基苯丁酸（APAH）250 mg，每日3次，14天）；第3阶段（氟伏沙明50 mg，每日1次，8周）；第4阶段（MTZ和TZS治疗、健身计划）。除上述9例患者外，还研究了15例（4例男性和11例女性，年龄36 - 47岁）符合纤维肌痛ACTTION - APS疼痛分类标准的伴有广泛疼痛的FBSS患者，他们仅每日服用米那普明25 - 50 mg，持续两个月（WSP - FBSS组）。
基线时，CSI和VAS如下：e-FBSS组中，CSI = 72.2±6.5；VAS = 58.5±8.8；m-FBSS组中，CSI = 49.2±9.0；VAS = 39.5±5.3；l-FBSS组中，CSI = 18.1±5.9；VAS = 18.1±5.4。所有患者均有活跃的MTZ和TZS。MTZ和TZS亚组之间的差异在于疼痛再现——在刺激（按压）MTZ或TZS时出现患者特有的疼痛。在e-FBSS组中，非甾体抗炎药疗效低；APAH疗效中等；氟伏沙明疗效高。在m-FBSS组中，观察到非甾体抗炎药和APAH疗效中等，氟伏沙明疗效高。在l-FBSS组中，非甾体抗炎药疗效高。在WSP - FBSS组中，治疗前VAS和CSI分别为58.8±9.2 mm和75.1±8.04，治疗2个月后分别为15.51±5.1 mm（P = 0.00032）和25.6±8.2（P = 0.00）。
对于FBSS患者，应考虑CS对MTZ和TZS进行治疗。该研究表明在存在CS的情况下，APAH、氟伏沙明和米那普明具有疗效。
