Department of Anesthesia, Perioperative Medicine and Pain Management, University of Miami, Jackson Health System, Miami, FL.
Pain Physician. 2021 Jul;24(4):E407-E423.
Evidence suggests that dorsal root ganglion stimulation (DRGS) is a more effective treatment for focal neuropathic pain (FNP) compared with tonic, paresthesia-based dorsal column spinal cord stimulation (SCS). However, new advancements in waveforms for dorsal column SCS have not been thoroughly studied or compared with DRGS for the treatment of FNP.
The purpose of this review was to examine the evidence for these novel technologies; to highlight the lack of high-quality evidence for the use of neuromodulation to treat FNP syndromes other than complex regional pain syndrome I or II of the lower extremity; to emphasize the absence of comparison studies between DRGS, burst SCS, and high-frequency SCS; and to underscore that consideration of all neuromodulation systems is more patient-centric than a one-size-fits-all approach.
This is a review article summarizing case reports, case series, retrospective studies, prospective studies, and review articles.
The University of Miami, Florida.
A literature search was conducted from February to March 2020 using the PubMed and EMBASE databases and keywords related to DRGS, burst SCS, HF10 (high-frequency of 10 kHz), and FNP syndromes. All English-based literature from 2010 reporting clinical data in human patients were included.
Data for the treatment of FNP using burst SCS and HF10 SCS are limited (n = 11 for burst SCS and n = 11 for HF10 SCS). The majority of these studies were small, single-center, nonrandomized, noncontrolled, retrospective case series and case reports with short follow-up duration. To date, there are only 2 randomized controlled trials for burst and HF10 for the treatment of FNP.
No studies were available comparing DRGS to HF10 or burst for the treatment of FNP. Data for the treatment of FNP using HF10 and burst stimulation were limited to a small sample size reported in mostly case reports and case series.
FNP is a complex disease, and familiarity with all available systems allows the greatest chance of success.
有证据表明，与持续刺激、感觉异常为基础的脊髓背柱刺激（SCS）相比，背根神经节刺激（DRGS）在治疗局灶性神经性疼痛（FNP）方面更有效。然而，脊髓背柱 SCS 新波形的进展尚未得到充分研究，也未与 DRGS 治疗 FNP 进行比较。
本综述的目的是检查这些新技术的证据；强调缺乏高质量的证据表明，除了下肢的复杂性区域疼痛综合征 I 或 II 以外，神经调节治疗 FNP 综合征的其他方法；强调 DRGS、爆发式 SCS 和高频 SCS 之间缺乏比较研究；并强调考虑所有神经调节系统比一刀切的方法更以患者为中心。
这是一篇综述文章，总结了病例报告、病例系列、回顾性研究、前瞻性研究和综述文章。
佛罗里达州迈阿密大学。
2020 年 2 月至 3 月，使用 PubMed 和 EMBASE 数据库以及与 DRGS、爆发式 SCS、HF10（高频 10 kHz）和 FNP 综合征相关的关键词进行了文献检索。纳入所有 2010 年以来报告人类患者临床数据的基于英语的文献。
使用爆发式 SCS 和 HF10 SCS 治疗 FNP 的数据有限（爆发式 SCS 为 11 例，HF10 SCS 为 11 例）。这些研究大多数是小型、单中心、非随机、非对照、回顾性病例系列和病例报告，随访时间短。迄今为止，仅有 2 项关于爆发式和 HF10 治疗 FNP 的随机对照试验。
没有研究比较 DRGS 与 HF10 或爆发式 SCS 治疗 FNP。使用 HF10 和爆发式刺激治疗 FNP 的数据仅限于大多是病例报告和病例系列报告的小样本量。
FNP 是一种复杂的疾病，熟悉所有可用的系统可以最大限度地提高成功的机会。
