Multidisciplinary Pain Center, Sint-Niklaas, Belgium.
Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; STIMULUS consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Universitair Ziekenhuis Brussel, Jette, Belgium; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium.
Neuromodulation. 2022 Jan;25(1):114-120. doi: 10.1111/ner.13384.
Patients eligible for spinal cord stimulation (SCS) generally experience excruciating pain, requiring more opioid consumption, which is usually an indication for SCS implantation. After final implantation, SCS has the ability to stabilize or decrease opioid usage in half of the patients. In this study, opioids were actively eliminated prior to implantation of any neuromodulation device with a standardized detoxification protocol. This pilot study aims to explore the feasibility, effectiveness, and safety of this opioid detoxification protocol prior to neuromodulation techniques.
In this retrospective pilot study, 70 patients who were taking opioids and who were eligible for neuromodulation techniques underwent the detoxification program. A combined in- and out-patient clinic protocol was applied, whereby clonidine was the main component of both parts of the program. A multidisciplinary team with pain physicians and psychologists was responsible for performing this detoxification program. Safety and feasibility were systematically recorded during the hospitalization.
No serious safety issues were reported. At the start of the program, patients reported a mild sedative effect of clonidine. Additionally, most patients presented mild symptoms of opioid withdrawal, which were partially countered by the sedative effect of clonidine. Both patients and the medical staff found this protocol feasible in clinical practice. Concerning the effectiveness, a statistically significant decrease in median morphine milligram equivalents (MMEs) was found with an MME of 175 (Q1-Q3: 118.1-240) at baseline, and at the last available follow-up visit the MME was 0 (Q1-Q3: 0-16.88).
This standardized detoxification program has proven its effectiveness, safety, and feasibility in this single-center experience pilot study in patients eligible for neuromodulation techniques.
有资格接受脊髓刺激 (SCS) 的患者通常会经历剧痛，需要更多的阿片类药物消耗，这通常是 SCS 植入的指征。最终植入后，SCS 有能力稳定或减少一半患者的阿片类药物使用。在这项研究中，使用标准化的戒毒方案，在植入任何神经调节装置之前，积极消除阿片类药物。这项试点研究旨在探索在神经调节技术之前使用这种阿片类药物戒毒方案的可行性、有效性和安全性。
在这项回顾性试点研究中，70 名正在服用阿片类药物且有资格接受神经调节技术的患者接受了戒毒方案。应用了门诊和住院相结合的诊所方案，可乐定是方案两部分的主要成分。一个由疼痛医师和心理学家组成的多学科团队负责执行该戒毒方案。在住院期间系统记录了安全性和可行性。
未报告严重的安全问题。在方案开始时，患者报告可乐定有轻微的镇静作用。此外，大多数患者出现了轻度的阿片类药物戒断症状，这些症状部分被可乐定的镇静作用抵消。患者和医务人员都认为该方案在临床实践中具有可行性。关于有效性，发现中位数吗啡毫克当量 (MME) 有显著下降，基线时 MME 为 175（Q1-Q3：118.1-240），最后一次随访时 MME 为 0（Q1-Q3：0-16.88）。
在这项有资格接受神经调节技术的患者的单中心经验性试点研究中，这种标准化戒毒方案已被证明具有有效性、安全性和可行性。
