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背根神经节刺激治疗慢性顽固性疼痛的前瞻性长期随访。

A prospective long-term follow-up of dorsal root ganglion stimulation for the management of chronic intractable pain.

机构信息

Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, United Kingdom.

Leeds Neuromodulation Centre, Leeds Teaching Hospitals, Leeds, United Kingdom.

出版信息

Pain. 2022 Apr 1;163(4):702-710. doi: 10.1097/j.pain.0000000000002405.

Abstract

Initial clinical studies have shown that the stimulation of the dorsal root ganglion (DRG) can significantly reduce chronic intractable pain. However, clinical data on long-term results and complications of these systems are limited. The aim of this prospective study is to report on a single center long-term follow-up of DRG stimulation for intractable chronic pain. Participants were implanted with DRG stimulation devices between 2013 and 2015 with an observation period of 24 months. Patients were contacted again in 2020 for a final follow-up (ie, between 5 and 7 years postimplantation). Forty-two participants were recruited, of whom 32 received the fully implantable pulse generator (IPG). At the final follow-up, 50% (16/32) of participants were still using DRG stimulation. Two participants still had the original IPG and 14 had received a replacement IPG. Pain scores were significantly reduced at 24 months, mean difference 1.7 (95% confidence interval: 0.2-3.3, P = 0.03), and at the last follow-up, mean difference 2.1 (95% confidence interval: 0.3-4, P = 0.03). Significant improvements were observed for health-related quality of life. The findings were generally robust to imputation methods of missing data. Implantable pulse generators of 8 patients were explanted because of dissatisfaction with pain relief. In conclusion, DRG stimulation can provide effective pain relief and improved quality of life in patients suffering with neuropathic pain, although this study had a revision rate of 42% within the first 24 months, and 56% of IPGs that were replaced because of battery depletion had a shorter than expected battery life.

摘要

初步临床研究表明,刺激背根神经节(DRG)可显著减轻慢性顽固性疼痛。然而,这些系统的长期结果和并发症的临床数据有限。本前瞻性研究旨在报告单中心对 DRG 刺激治疗慢性顽固性疼痛的长期随访结果。参与者于 2013 年至 2015 年植入 DRG 刺激装置,观察期为 24 个月。2020 年再次联系患者进行最终随访(即植入后 5 至 7 年)。共招募了 42 名参与者,其中 32 名接受了全植入脉冲发生器(IPG)。在最终随访时,50%(16/32)的参与者仍在使用 DRG 刺激。2 名参与者仍使用原始 IPG,14 名参与者更换了 IPG。24 个月时疼痛评分显著降低,平均差异为 1.7(95%置信区间:0.2-3.3,P = 0.03),最后一次随访时平均差异为 2.1(95%置信区间:0.3-4,P = 0.03)。健康相关生活质量也显著改善。缺失数据的插补方法一般对结果稳健。8 名患者的植入脉冲发生器因对疼痛缓解不满意而被取出。总之,DRG 刺激可有效缓解神经病理性疼痛患者的疼痛并提高生活质量,尽管本研究在最初 24 个月内有 42%的翻修率,且因电池耗尽而更换的 56%的 IPG 电池寿命短于预期。

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