Hoydonckx Yasmine, Costanzi Matteo, Bhatia Anuj
Department of Anesthesia and Pain Medicine, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.
Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
Can J Pain. 2019 Mar 5;3(1):33-48. doi: 10.1080/24740527.2019.1574536. eCollection 2019.
: Paresthesia-based spinal cord stimulation (PB-SCS) is used for the treatment of complex regional pain syndrome (CRPS), but many patients are refractory to PB-SCS or experience attenuation of analgesic effect over time due to tolerance. Novel SCS modes including high-frequency, Burst, and high-density (HD) stimulation were introduced recently and this systematic review was conducted to summarize the evidence on their role for CRPS. : We searched MEDLINE and other databases (up to September 21, 2017) for studies including adults with refractory CRPS treated by paresthesia-free SCS (PF-SCS) modes compared to placebo, conventional medical treatment, or PB-SCS. We determined the posttreatment intensity of pain (up to 24 months after intervention), changes in CRPS-associated symptoms, and associated domains. Sustainability and adverse effects were also assessed. : We identified 13 studies (seven case series, five conference abstracts, one randomized controlled trial) including 62 patients with upper or lower limb CRPS. Eleven papers reported on outcomes of high-frequency stimulation at 10 kHz (HF-10) and other high frequencies, two papers were on Burst, and one paper was on HD. In 59 patients, pain intensity with novel SCS modes was reduced by 30% to 100% with a corresponding reduction in analgesic medications. Novel SCS modes also attenuated CRPS-associated symptoms and six papers reported significant improvement of quality of life. : Novel SCS modes have the potential to provide analgesia in patients with CRPS. However, the low quality of available evidence necessitates definitive and prospective comparative effectiveness studies to establish the role of these modes in CRPS.
基于感觉异常的脊髓刺激（PB-SCS）用于治疗复杂性区域疼痛综合征（CRPS），但许多患者对PB-SCS无效，或因耐受性随时间推移出现镇痛效果减弱。最近引入了包括高频、爆发式和高密度（HD）刺激在内的新型脊髓刺激模式，本系统评价旨在总结其对CRPS作用的证据。我们检索了MEDLINE和其他数据库（截至2017年9月21日），以查找将无感觉异常脊髓刺激（PF-SCS）模式治疗难治性CRPS的成人患者与安慰剂、传统药物治疗或PB-SCS进行比较的研究。我们确定了治疗后疼痛强度（干预后长达24个月）、CRPS相关症状的变化以及相关领域。还评估了可持续性和不良反应。我们纳入了13项研究（7个病例系列、5篇会议摘要、1项随机对照试验），包括62例上肢或下肢CRPS患者。11篇论文报告了10kHz高频刺激（HF-10）和其他高频的结果，2篇论文是关于爆发式刺激的，1篇论文是关于HD刺激的。在59例患者中，新型脊髓刺激模式使疼痛强度降低了30%至100%，同时镇痛药物用量相应减少。新型脊髓刺激模式还减轻了CRPS相关症状，6篇论文报告生活质量有显著改善。新型脊髓刺激模式有可能为CRPS患者提供镇痛效果。然而，现有证据质量较低，需要进行确定性的前瞻性比较有效性研究，以确定这些模式在CRPS中的作用。
