Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
Eur J Pain. 2022 Aug;26(7):1581-1593. doi: 10.1002/ejp.1984. Epub 2022 Jun 13.
Spinal cord stimulation (SCS) can impact sensory, pain and tolerance thresholds in various ways, which can be accessed via quantitative sensory testing (QST). The objectives of this study were to (1) assess the subjective sensory responses using QST in patients following SCS therapy for PSPS and (2) to get a clinical impression of the results of SCS during an interview of these patients with PSPS and SCS during long term follow-up.
Forty patients with PSPS who received SCS treatment underwent QST via electrical and mechanical pressure stimuli. QST was performed at four different moments (1) pre-implantation SCS, (2) two weeks postoperatively, (3) three months after permanent SCS implantation and (4) six months after permanent SCS implantation. Patients' perspectives on pain, use of drugs and quality of life were assessed via semi-structured interviews during a follow-up between 5 and 11 years.
We found statistical significant differences in the changes of sensory, pain and tolerance thresholds. A decrease in pain complaints and analgesics use were reported by the patients during follow-up. The quality of life in patients increased from three to eight (NRS 0 [worst QoL imaginable] -10 [best QoL imaginable]) after receiving SCS.
The increased thresholds on areas without pain or being covered by the SCS induced paresthesias may indicate that there are central changes contributing to these deviations in thresholds. The overall QoL in patients improved greatly after receiving SCS.
This study provides an overview of the effect of SCS on sensory, pain and tolerance thresholds in patients with PSPS throughout the SCS treatment process. In addition, this study presents data from 40 patients with PSPS treated with SCS, analysing several long-term patient-reported outcome measures. The results serve to give more insight into the mechanism of SCS and document SCS as a possible treatment for PSPS.
脊髓刺激 (SCS) 可以通过定量感觉测试 (QST) 以各种方式影响感觉、疼痛和耐受阈值。本研究的目的是：(1) 通过 QST 评估接受 SCS 治疗后 PSPS 患者的主观感觉反应；(2) 通过对这些接受 SCS 治疗的 PSPS 患者进行长期随访的访谈，获得对 SCS 结果的临床印象。
40 名接受 SCS 治疗的 PSPS 患者接受了电和机械压力刺激的 QST。QST 在四个不同时间点进行：(1) 植入前 SCS；(2) 术后两周；(3) 永久性 SCS 植入后三个月；(4) 永久性 SCS 植入后六个月。在 5 至 11 年的随访期间，通过半结构化访谈评估患者对疼痛、药物使用和生活质量的看法。
我们发现感觉、疼痛和耐受阈值的变化存在统计学显著差异。在随访过程中，患者报告疼痛抱怨和镇痛药使用减少。接受 SCS 后，患者的生活质量从 3 分增加到 8 分（NRS 0 [最差想象的生活质量] -10 [最好想象的生活质量]）。
无疼痛或被 SCS 覆盖区域的阈值增加可能表明存在中枢变化，导致这些阈值偏差。接受 SCS 后，患者的整体生活质量大大提高。
本研究提供了 SCS 对 PSPS 患者整个 SCS 治疗过程中感觉、疼痛和耐受阈值影响的概述。此外，本研究还提供了 40 名接受 SCS 治疗的 PSPS 患者的数据，分析了几项长期患者报告的结果测量。研究结果有助于深入了解 SCS 的机制，并证明 SCS 是治疗 PSPS 的一种可能方法。
