鞘内药物输注和脊髓刺激治疗难治性癌痛
Management of Refractory Cancer Pain with Intrathecal Drug Delivery and Spinal Cord Stimulation.
作者信息
Bulat Evgeny, Crowther Jason E, Chakravarthy Vikram, Laufer Ilya, Barzilai Ori, Gulati Amitabh
机构信息
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
出版信息
Palliat Med Rep. 2024 Aug 2;5(1):301-305. doi: 10.1089/pmr.2023.0089. eCollection 2024.
BACKGROUND
Intrathecal pumps (ITPs) are indicated for refractory cancer pain and decrease systemic opioid requirements. While not yet indicated for cancer pain, spinal cord stimulators (SCSs) are used off-label for cancer pain, with increasing evidence of their efficacy.
MATERIALS AND METHODS
A retrospective chart review was conducted of patients who underwent both ITP and at least SCS trial for cancer pain. Primary outcomes were pain numeric rating scale (NRS) and daily morphine equivalents (MEQs).
RESULTS
Seventeen patients were identified. Both ITP and SCS were associated with significant decreases in pain ratings at the 3-month follow-up, but this decrease became nonsignificant subsequently. ITP, but not SCS, was associated with a significant decrease in MEQ.
CONCLUSIONS
ITP and SCS may both provide efficacy for cancer pain, but the opioid-sparing effects of SCS may be limited. ITP and SCS may potentially be complementary in their ability to provide relief from cancer-related pain.
背景
鞘内注射泵（ITP）适用于难治性癌痛，并可减少全身阿片类药物的用量。虽然脊髓刺激器（SCS）尚未被批准用于癌痛，但目前已被用于癌痛的非适应证治疗，且越来越多的证据表明其疗效显著。
材料与方法
对同时接受ITP和至少一次SCS癌痛试验的患者进行回顾性病历审查。主要观察指标为疼痛数字评分量表（NRS）和每日吗啡当量（MEQ）。
结果
共纳入17例患者。在3个月的随访中，ITP和SCS均与疼痛评分显著降低相关，但随后这种降低变得不显著。ITP与MEQ显著降低相关，而SCS则不然。
结论
ITP和SCS均可有效缓解癌痛，但SCS的阿片类药物节省作用可能有限。ITP和SCS在缓解癌痛方面可能具有潜在的互补作用。
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