Wong Chun Ho, Chan Timmy Chi Wing, Wong Stanley Sau Ching, Russo Marc, Cheung Chi Wai
Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China.
Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, China.
Neuromodulation. 2023 Apr;26(3):538-551. doi: 10.1016/j.neurom.2022.07.011. Epub 2022 Sep 1.
Various approaches have been developed with a view to treating the back pain component in patients with chronic low back pain (CLBP) and persistent spinal pain syndrome (PSPS). Emerging evidence shows that peripheral nerve field stimulation (PNFS) may be an efficacious therapeutic modality against axial low back pain. Hence, the aim of the review was to evaluate the analgesic efficacy and safety of PNFS, when used alone or as an adjunct to spinal cord stimulation (SCS), for managing CLBP and PSPS.
A comprehensive search for clinical studies on PNFS and PNFS + SCS used for the management of CLBP and/or PSPS was performed using PubMed, EMBASE, MEDLINE via Proquest, and Web of Science.
A total of 15 studies were included, of which four were randomized controlled trials (RCTs), nine were observational studies, and two were case series. For patients receiving PNFS, a significant decrease in back pain intensity and analgesic consumption, together with a significant improvement in physical functioning, was observed upon implant of the permanent system. Meanwhile, the addition of PNFS to SCS in refractory cases was associated with a significant reduction in back and leg pain, respectively.
This review suggests that PNFS, when used alone or in combination with SCS, appears to be effective in managing back pain. However, high-quality evidence that supports the long-term analgesic efficacy and safety is still lacking. Hence, RCTs with a larger patient population and of a longer follow-up duration are warranted.
已经开发出各种方法来治疗慢性下腰痛（CLBP）和持续性脊柱疼痛综合征（PSPS）患者的背痛症状。新出现的证据表明，外周神经场刺激（PNFS）可能是治疗轴性下腰痛的一种有效治疗方式。因此，本综述的目的是评估PNFS单独使用或作为脊髓刺激（SCS）辅助手段治疗CLBP和PSPS时的镇痛效果和安全性。
通过PubMed、EMBASE、经由Proquest检索的MEDLINE以及Web of Science对关于PNFS和PNFS + SCS用于治疗CLBP和/或PSPS的临床研究进行全面检索。
共纳入15项研究，其中4项为随机对照试验（RCT），9项为观察性研究，2项为病例系列研究。对于接受PNFS治疗的患者，植入永久性系统后观察到背痛强度和镇痛药消耗量显著降低，同时身体功能有显著改善。同时，在难治性病例中，将PNFS添加到SCS中分别与背痛和腿痛的显著减轻相关。
本综述表明，PNFS单独使用或与SCS联合使用似乎对治疗背痛有效。然而，仍然缺乏支持其长期镇痛效果和安全性的高质量证据。因此，有必要开展更大样本量、更长随访期的RCT研究。
