用于治疗胸椎椎体顽固性转移性背痛的背根神经节热射频、脉冲射频和类固醇之间的随机对照试验。

Randomized controlled trials between dorsal root ganglion thermal radiofrequency, pulsed radiofrequency and steroids for the management of intractable metastatic back pain in thoracic vertebral body.

作者信息

Fanous Sherry Nabil, Saleh Emad Gerges, Abd Elghafar Ekramy Mansour, Ghobrial Hossam Zarif

机构信息

Department of Anaesthesia, ICU and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt.

出版信息

Br J Pain. 2021 Aug;15(3):270-281. doi: 10.1177/2049463720942538. Epub 2020 Aug 11.

DOI:10.1177/2049463720942538

PMID:34381612

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8339942/

Abstract

BACKGROUND

Bone metastasis is a complication of various cancers causing severe pain. The current modalities for the treatment of metastatic axial pain include pharmacological, surgical and vertebral augmentation techniques, each of which has its own challenges.

OBJECTIVES

To evaluate the effectiveness of pulsed radiofrequency (PRF), thermal radiofrequency (RF) and steroids on dorsal root ganglion (DRG) in patients with thoracic axial pain due to vertebral metastasis.

METHODS

In this randomized controlled prospective study, 140 patients were assessed for eligibility, of which only 69 fulfilled the criteria. Patients were randomly divided into three equal groups, PRF, RF and steroid.

RESULTS

During the assessment of pain using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Opioid consumption using oral Morphine Equivalence (OME) and Analgesic Quantification Algorithm (AQA) - at baseline, 1 week, 1 month and 3 months - 81 patients were assessed for final eligibility, of which 12 were excluded before intervention due to drop-out. The remaining 69 were randomized (mean age: 53.87 ± 10.55, 55.78 ± 7.34 and 59.39 ± 13.72) for PRF, RF and steroid, respectively with no statistical difference. VAS% and ODI% decreased significantly at 3 months in RF group ( <0.001, 0.014, respectively), as did the AQA ( <0.027). Steroid group was the worst.

DISCUSSION

RF on DRG is the main stay for controlling intractable metastatic pain. PRF is a good alternative.

摘要

背景

骨转移是多种癌症的一种并发症，会导致严重疼痛。目前治疗转移性轴向疼痛的方法包括药物治疗、手术治疗和椎体强化技术，每种方法都有其自身的挑战。

目的

评估脉冲射频（PRF）、热射频（RF）和类固醇对因椎体转移导致胸段轴向疼痛患者的背根神经节（DRG）的疗效。

方法

在这项随机对照前瞻性研究中，对140例患者进行了资格评估，其中只有69例符合标准。患者被随机分为三组，每组人数相等，分别为PRF组、RF组和类固醇组。

结果

在使用视觉模拟量表（VAS）、奥斯威斯利功能障碍指数（ODI）、口服吗啡等效剂量（OME）的阿片类药物消耗量和镇痛量化算法（AQA）评估疼痛时——在基线、1周、1个月和3个月时——对81例患者进行了最终资格评估，其中12例在干预前因退出而被排除。其余69例分别随机分为PRF组、RF组和类固醇组（平均年龄分别为：53.87±10.55、55.78±7.34和59.39±13.72），无统计学差异。RF组在3个月时VAS%和ODI%显著下降（分别<0.001、0.014），AQA也下降（<0.027）。类固醇组效果最差。