Abd-Elsayed Alaa, Gyorfi Michael, Fischman Michael, Odonkor Charles, Siff Bradford, Cyr Kevin
Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA.
Center for Interventional Pain and Spine, Lancaster, PA, USA.
Pain Ther. 2023 Apr;12(2):553-562. doi: 10.1007/s40122-023-00480-7. Epub 2023 Feb 20.
INTRODUCTION: The peripheral nervous system is an increasingly popular target for chronic pain treatment modalities. Noninvasive neuromodulation has shown promise at providing significant chronic pain relief with a much safer side effect profile. This retrospective pilot study is shaped around a noninvasive neuromodulation system over a 2-week treatment timeline. METHODS: Open-label survey of chronic pain patients recruited from Veteran Affairs, orthopedic, and pain health systems. If a noninvasive neuromodulation system was prescribed the patients were then offered a 2-week follow-up survey. This voluntary survey did not affect their therapy duration or quality. This survey was designed to address similar metrics as smaller noninvasive neuromodulation studies to allow a quality comparison while giving more power with a large population size of 1511 patients. Overall pain scores (including before and after scores), satisfaction level, desire to continue therapy, medication use, effect on functional metrics (mood, sleep, sit, stand, walk, and lift), and activities of daily living (ADL) scores were assessed. RESULTS: The results demonstrated an overall pain reduction of 46%. All functional metrics were improved throughout with the largest improvements reported in mood and sleep at over 47%. Medication use was reported as decreased or eliminated in 42% of patients. There were no adverse reactions or complications reported over the 1511 patients. CONCLUSION: This survey is amongst the largest population sizes every studied for noninvasive neuromodulation. Within just 2 weeks patients can see a reduction in overall pain and medication needs. Although survey studies have inherent limitations such as duration and compliance biases with such an overwhelming benefit in every category we believe that noninvasive neuromodulation therapy is a promising, safe, and cost-effective therapy. Future studies should focus on long-term follow-ups and post-therapy pain scores with a placebo group.
引言:外周神经系统日益成为慢性疼痛治疗方式的热门靶点。非侵入性神经调节已显示出有望提供显著的慢性疼痛缓解效果,且副作用风险低得多。这项回顾性试点研究围绕一种非侵入性神经调节系统展开,治疗时间为2周。 方法:对从退伍军人事务部、骨科和疼痛健康系统招募的慢性疼痛患者进行开放标签调查。如果开具了非侵入性神经调节系统的处方,患者将接受为期2周的随访调查。这项自愿调查不影响他们的治疗时长或质量。该调查旨在针对与较小规模的非侵入性神经调节研究类似的指标,以便进行质量比较,同时纳入1511名患者的大样本量能提供更强的说服力。评估总体疼痛评分(包括治疗前后评分)、满意度、继续治疗的意愿、药物使用情况、对功能指标(情绪、睡眠、坐、站、行走和提举)的影响以及日常生活活动(ADL)评分。 结果:结果显示总体疼痛减轻了46%。所有功能指标均有所改善,其中情绪和睡眠改善最为显著,超过47%。42%的患者报告药物使用减少或停用。在1511名患者中未报告不良反应或并发症。 结论:这项调查是针对非侵入性神经调节研究的最大样本量之一。仅在2周内,患者就能看到总体疼痛和药物需求的减少。尽管调查研究存在诸如时长和依从性偏差等固有局限性,但鉴于在各个类别中都有如此巨大的益处,我们认为非侵入性神经调节疗法是一种有前景、安全且具有成本效益的疗法。未来的研究应侧重于长期随访以及与安慰剂组对比的治疗后疼痛评分。
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