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10kHz脊髓刺激疗法治疗患者的阿片类药物消耗量减少及持久疼痛缓解:单中心结局的回顾性分析

Decreased Opioid Consumption and Durable Pain Relief in Patients Treated with 10 kHz SCS: A Retrospective Analysis of Outcomes from Single-Center.

作者信息

Feng Honghui, Doherty Patrick, Rotte Anand

机构信息

Lawrence and Memorial Hospital, Yale New Haven Healthcare, New London, CT, USA.

Nevro Corp., Redwood City, CA, USA.

出版信息

J Pain Res. 2021 Aug 24;14:2593-2600. doi: 10.2147/JPR.S312932. eCollection 2021.

Abstract

BACKGROUND

Chronic pain is frequently treated with opioid analgesics, but there is limited evidence for efficacy for chronic use of opioids and the drugs pose significant risks to patients' physical and mental health. Spinal cord stimulation delivered at a frequency of 10,000 Hertz (10 kHz SCS) is a minimally invasive therapy with demonstrated efficacy and safety in treating chronic pain that has also been associated with decreased opioid use.

OBJECTIVE

To evaluate opioid reduction and pain relief in real-world cohort.

STUDY DESIGN

Retrospective review.

SETTING

Single center.

PATIENTS AND METHODS

Consecutive patients who were implanted with 10 kHz SCS devices from December 1, 2015, to June 30, 2020 for the treatment of chronic pain in the trunk or lower limbs were included. Changes in opioid use following 10 kHz SCS treatment were extracted from electronic medical records, and patient-reported pain relief, improvement in function and sleep were extracted from manufacturer's database. Responder rate was defined as the proportion of patients with at least 50% pain relief. Anonymised results from descriptive analysis of the data are reported.

RESULTS

At last follow-up (median 21.4 months), mean daily opioid dose fell by 48.4 morphine milligram equivalents (MME), and fewer patients used opioids. Mean pain relief in these patients was 57% ± 4%, and responder rate was 68% at last recorded follow-up. Interestingly, pain relief (66%) and responder rate (86%) were higher in patients with 1 year or more. Finally, 50% of patients reported improved sleep, and 73% reported improvement in function at last recorded follow-up after treatment with 10 kHz SCS.

CONCLUSION

These results support 10 kHz SCS as a safe and effective treatment of chronic pain in real-world patients with secondary benefits to opioid consumption and measures of patients' quality of life.

摘要

背景

慢性疼痛常使用阿片类镇痛药治疗,但关于阿片类药物长期使用的疗效证据有限,且这些药物对患者的身心健康构成重大风险。以10000赫兹频率进行的脊髓刺激(10kHz脊髓刺激)是一种微创治疗方法,在治疗慢性疼痛方面已证明其有效性和安全性,同时也与阿片类药物使用减少有关。

目的

评估真实世界队列中阿片类药物用量的减少情况和疼痛缓解情况。

研究设计

回顾性研究。

研究地点

单中心。

患者和方法

纳入2015年12月1日至2020年6月30日期间因治疗躯干或下肢慢性疼痛而植入10kHz脊髓刺激装置的连续患者。从电子病历中提取10kHz脊髓刺激治疗后阿片类药物使用的变化情况,并从制造商数据库中提取患者报告的疼痛缓解情况、功能改善情况和睡眠改善情况。缓解率定义为疼痛缓解至少50%的患者比例。报告对数据进行描述性分析的匿名结果。

结果

在最后一次随访时(中位时间21.4个月),平均每日阿片类药物剂量下降了48.4毫克吗啡当量(MME),使用阿片类药物的患者减少。这些患者的平均疼痛缓解率为57%±4%,在最后一次记录的随访时缓解率为68%。有趣的是,病程1年或更长时间的患者疼痛缓解率(66%)和缓解率(86%)更高。最后,50%的患者报告睡眠改善,73%的患者在接受10kHz脊髓刺激治疗后的最后一次记录随访时报告功能改善。

结论

这些结果支持10kHz脊髓刺激作为治疗真实世界患者慢性疼痛的一种安全有效的方法,对阿片类药物使用和患者生活质量指标有额外益处。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4371/8403026/d573cedfebe4/JPR-14-2593-g0001.jpg

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