多学科团队会议在神经调节候选患者中的应用有助于患者的选择和优化。

Application of multidisciplinary team conference for neuromodulation candidates facilitates patient selection and optimization.

作者信息

Salmasi Vafi, Rasouli Mohammad Reza, Kao Ming C, Ottestad Einar, Terkawi Abdullah Sulieman, Morris Garret, Qian Xiang, Coleman Stephen, Talavera David C, Poupore-King Heather, Slater Kristen, Leong Michael S

机构信息

Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.

出版信息

Front Pain Res (Lausanne). 2024 Jan 5;4:1331883. doi: 10.3389/fpain.2023.1331883. eCollection 2023.

DOI:10.3389/fpain.2023.1331883

PMID:38249566

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10796794/

Abstract

INTRODUCTION

Psychological evaluation is required by insurance companies in the United States prior to proceeding with a spinal cord stimulation or a dorsal root ganglion stimulation trial. Since January 2017, we implemented a Multidisciplinary Team Conference for Neuromodulation in our center to facilitate the collaboration between pain physicians and psychologists and to optimize screening of neuromodulation candidates. This study aims to report the impact of this team conference on improvement of neuromodulation outcome in our center.

METHODS

Appropriateness of neuromodulation were discussed in the team conference after initial visit with the pain specialist and psychological evaluation. For this study, we prospectively and retrospectively collected data on neuromodulation candidates who went through the team conference and those who did not as controls.

RESULTS

We discussed 461 patients in the team conference sessions from January 2017 to July 2023. Out of these, a spinal cord stimulator or a dorsal root ganglion stimulator trial was performed in 164 patients with 80.5% (132 cases) trial success rate leading to 140 implants. Out of these implants, 26 (18.6%) explanted and 21 (15%) required revision in 41 (29.3%) patients. We performed neuraxial neuromodulation trial for 70 patients without going through the team conference from January 2016 to July 2023 with a trial success rate of 45.7% (32 cases). In this group, 7 (21.9%) and 6 (18.8%) patients underwent explant and revision. The differences between the groups were statistically significant for trial success rate (odds ratio of 4.9 with -value of <0.01) but not for explant (odds ratio of 0.8 with -value of 0.627) or revision (odds ratio of 0.8 with -value of 0.595).

CONCLUSION

Implementing Multidisciplinary Team Conference increased trial success rate in our center. Team conference provides therapeutic benefit for patients, and also provides the opportunity for an educational discussion for trainees.

摘要

引言

在美国，保险公司在进行脊髓刺激或背根神经节刺激试验之前需要进行心理评估。自2017年1月以来，我们中心实施了神经调节多学科团队会议，以促进疼痛科医生和心理学家之间的合作，并优化神经调节候选者的筛选。本研究旨在报告该团队会议对改善我们中心神经调节结果的影响。

方法

在初次就诊于疼痛专科医生并进行心理评估后，在团队会议上讨论神经调节的适用性。对于本研究，我们前瞻性和回顾性地收集了参加团队会议的神经调节候选者以及未参加团队会议作为对照的候选者的数据。

结果

2017年1月至2023年7月期间，我们在团队会议上讨论了461例患者。其中，164例患者进行了脊髓刺激器或背根神经节刺激器试验，试验成功率为80.5%（132例），最终植入140例。在这些植入病例中，26例（18.6%）被取出，41例（29.3%）患者中的21例（15%）需要进行翻修。2016年1月至2023年7月期间，我们对70例未参加团队会议的患者进行了神经轴突神经调节试验，试验成功率为45.7%（32例）。在该组中，7例（21.9%）和6例（18.8%）患者分别接受了取出和翻修手术。两组之间的试验成功率差异具有统计学意义（优势比为4.9，P值<0.01），但取出（优势比为0.8，P值为0.627）或翻修（优势比为0.8，P值为0.595）差异无统计学意义。