Pain Management Department, Leeds Teaching Hospitals National Health Service Trust, Leeds, UK.
Pain Management Department, Leeds Teaching Hospitals National Health Service Trust, Leeds, UK; School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK.
Neuromodulation. 2024 Aug;27(6):1035-1044. doi: 10.1016/j.neurom.2024.04.008. Epub 2024 Jun 4.
Complex regional pain syndrome (CRPS) can profoundly affect many aspects of everyday life. Spinal cord stimulation (SCS) is a potential therapeutic option. This retrospective, single-site evaluation explored health-related quality of life (HRQoL) in individuals with CRPS treated with SCS in our Pain Service.
All patients aged ≥18 years with fully implanted SCS for CRPS between June 2013 and January 2023 were identified from hospital records. The following data were collected: sex, age, chronic pain diagnosis, CRPS type (I or II), location of CRPS (upper or lower limb), years of CRPS before first SCS implant, SCS system, preimplant and follow-up scores for HRQoL (euroqol 5 dimensions 3 levels [EQ-5D-3L] index score), average pain, worst pain and the influence of pain on aspects of everyday life (all numerical rating scale [NRS]), patient and clinician global impression of change at follow-up, and the occurrence and reasons for revisions and explants. An intention-to-treat approach was used and data statistically analyzed.
The final cohort comprised 83 patients (46 women), with a median (minimum, maximum) follow-up duration of 29 months (seven, 72). There were statistically and clinically significant improvements in HRQoL, despite relatively low pain response rates. The pain response rate was 34% (reduction of ≥30% in average pain NRS); the pain remission rate was 13% (average pain score ≤3 NRS), and all patients had preimplant EQ-5D-3L index values below the population norm of 0.82. However, 60% of patients reported EQ-5D-3L index scores greater than the published minimally important difference of 0.074, and scores were better at follow-up than at preimplant (p < 0.001); 44% of patients and 41% of clinicians reported improved symptoms at the most recent follow-up. Explants occurred in eight of 83 patients (10%).
Patients had meaningful improvements in HRQoL, which is a key outcome in ascertaining the overall outcome of SCS in CRPS. Randomized controlled clinical trials should build on the findings to improve understanding of the benefits and risks of treating CRPS with SCS.
复杂性区域疼痛综合征（CRPS）会深刻影响日常生活的许多方面。脊髓刺激（SCS）是一种潜在的治疗选择。本回顾性、单中心研究探索了我们疼痛科中接受 SCS 治疗的 CRPS 患者的健康相关生活质量（HRQoL）。
从医院记录中确定了 2013 年 6 月至 2023 年 1 月期间年龄≥18 岁、因 CRPS 接受完全植入式 SCS 的所有患者。收集了以下数据：性别、年龄、慢性疼痛诊断、CRPS 类型（I 型或 II 型）、CRPS 部位（上肢或下肢）、首次植入 SCS 前的 CRPS 持续时间、SCS 系统、植入前和随访时的 HRQoL（欧洲五维健康量表 3 级[EQ-5D-3L]指数评分）、平均疼痛、最差疼痛以及疼痛对日常生活各方面的影响（均为数字评分量表[NRS]）、随访时患者和临床医生对变化的整体印象，以及修订和取出的发生和原因。采用意向治疗方法进行数据分析。
最终队列包括 83 例患者（46 例女性），中位（最小、最大）随访时间为 29 个月（7、72）。尽管疼痛缓解率相对较低，但 HRQoL 仍有显著改善。疼痛缓解率为 34%（平均疼痛 NRS 降低≥30%）；疼痛缓解率为 13%（平均疼痛评分≤3 NRS），所有患者植入前的 EQ-5D-3L 指数值均低于 0.82 的人群正常值。然而，60%的患者报告 EQ-5D-3L 指数评分大于已发表的 0.074 最小临床重要差异，且随访时的评分优于植入前（p<0.001）；44%的患者和 41%的临床医生报告在最近一次随访时症状改善。83 例患者中有 8 例（10%）发生了取出。
患者的 HRQoL 有显著改善，这是确定 SCS 在 CRPS 中的总体治疗效果的关键结局。随机对照临床试验应在此基础上进行，以提高对 SCS 治疗 CRPS 的益处和风险的认识。
