Anesthesia, Critical Care, and Multidisciplinary Pain Management Department, Consorci Hospital General Universitari de València, Valencia, Spain
Anesthesia Unit. Surgical Specialties Department, Universidad de Valencia Facultad de Medicina y Odontología, Valencia, Spain.
Reg Anesth Pain Med. 2024 Mar 4;49(3):155-162. doi: 10.1136/rapm-2022-103962.
Chronic pain involves a structured and individualized development of neurophysiological and biological responses. The final expression in each patient correlates with diverse expressions of mediators and activations of different transmission and modulation pathways, as well as alterations in the structure and function of the brain, all of which develop according to the pain phenotype. Still today, the selection process for the ideal candidate for spinal cord stimulation (SCS) is based on results from test and functional variables analysis as well as pain evaluation. In addition to the difficulties in the initial selection of patients and the predictive analysis of the test phase, which undoubtedly impact on the results in the middle and long term, the rate of explants is one of the most important concerns, in the analysis of suitability of implanted candidates. A potential for useful integration of genome analysis and lymphocyte expression in the daily practice of neurostimulation, for pain management is presented. Structural and functional quantitative information provided by imaging biomarkers will allow establishing a clinical decision support system that improve the effectiveness of the SCS implantation, optimizing human, economic and psychological resources. A correct programming of the neurostimulator, as well as other factors associated with the choice of leads and their position in the epidural space, are the critical factors for the effectiveness of the therapy. Using a model of SCS based on mathematical methods and computational simulation, the effect of different factors of influence on clinical practice studied, as several configurations of electrodes, position of these, and programming of polarities, in order to draw conclusions of clinical utility in neuroestimulation therapy.
慢性疼痛涉及神经生理和生物反应的结构化和个体化发展。每个患者的最终表现都与不同的介质表达以及不同的传递和调制途径的激活相关，以及大脑结构和功能的改变，所有这些都是根据疼痛表型发展的。时至今日，脊髓刺激（SCS）理想候选者的选择过程仍基于测试和功能变量分析以及疼痛评估的结果。除了患者初始选择和测试阶段预测分析的困难，这无疑会对中长期结果产生影响外，植入候选者的合适性分析中，最令人关注的问题之一是，是否需要进行再次手术。神经刺激的日常实践中，基因组分析和淋巴细胞表达的潜在有用性，为疼痛管理提供了一种新的可能。成像生物标志物提供的结构和功能定量信息将建立一个临床决策支持系统，从而提高 SCS 植入的有效性，优化人力、经济和心理资源。神经刺激器的正确编程，以及与导联选择及其在硬膜外腔位置相关的其他因素，是治疗有效性的关键因素。使用基于数学方法和计算模拟的 SCS 模型，研究了不同影响因素对临床实践的影响，包括电极的几种配置、这些电极的位置以及极性的编程，以便在神经刺激治疗中得出具有临床应用价值的结论。
