Lee Jennifer M, Lee David, Christiansen Sandy, Hagedorn Jonathan M, Chen Zheyan, Deer Timothy
Department of Sports & Spine, EvergreenHealth Medical Group, Kirkland, WA, USA.
Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA.
J Pain Res. 2022 Oct 19;15:3263-3273. doi: 10.2147/JPR.S372921. eCollection 2022.
Chronic bleeding disorders, allergy to implants, and chronic infections are all complicating factors when considering neuromodulation therapies. The American Society of Pain and Neuroscience (ASPN) determined a need for clinical guidance in these special patient populations that have increased risk of complications, in order to ensure patient safety and optimal outcomes with device implantation. The purpose of this publication was to review the published literature and explore the unique clinical challenges encountered among several special patient populations with relation to spinal cord stimulation. The executive board of the ASPN appointed a diverse group of well-established physicians to develop best practice guidelines regarding spinal cord stimulation implantation in these special populations. The physicians used the United States Preventive Services Task Force (USPSTF) structured guidelines for grading and level of certainty to make evidence-based recommendations about clinical practice. Where sufficient evidence was lacking to justify a USPSTF ranking, the physicians queried experts in neuromodulation and achieved consensus. These best practices and interventional guideline found the evidence for the use of neuromodulation in specialized patient populations to be relatively modest.
在考虑神经调节疗法时，慢性出血性疾病、对植入物过敏以及慢性感染都是复杂因素。美国疼痛与神经科学学会（ASPN）确定，对于这些并发症风险增加的特殊患者群体，需要临床指导，以确保患者安全和植入设备后的最佳效果。本出版物的目的是回顾已发表的文献，并探讨在与脊髓刺激相关的几个特殊患者群体中遇到的独特临床挑战。ASPN执行委员会任命了一组多元化的知名医生，以制定关于在这些特殊人群中进行脊髓刺激植入的最佳实践指南。医生们使用美国预防服务工作组（USPSTF）的结构化分级指南和确定性水平，对临床实践提出基于证据的建议。在缺乏足够证据来证明USPSTF排名合理的情况下，医生们咨询了神经调节领域的专家并达成了共识。这些最佳实践和干预指南发现，在特殊患者群体中使用神经调节的证据相对较少。
