Guven Kose Selin, Kose Halil Cihan, Celikel Feyza, Akkaya Omer Taylan
Health Science University Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Department of Pain Medicine, Ankara, Turkey.
Health Science University Diskapi Yildirim Beyazit Training and Research Hospital, Department of Pain Medicine, Ankara, Turkey.
Interv Pain Med. 2022 Sep 15;1(4):100145. doi: 10.1016/j.inpm.2022.100145. eCollection 2022 Dec.
The first aim of this study was to investigate the analgesic efficacy of US-guided caudal epidural pulsed radiofrequency (PRF) stimulation in patients with failed back surgery syndrome (FBSS); the second was to evaluate the effects on opioid use, disability, quality of life and patient satisfaction.
Thirty patients with > 6-month history of chronic leg pain of >4 on a numerical rating scale (NRS) due to FBSS were included. These patients had unsatisfactory responses to conventional treatments and at least two epidural steroid injections. PRF stimulation with ultrasound guidance was administered to the caudal epidural space. NRS was evaluated before treatment, at 2, 4, and 8 weeks after intervention. Short Form-36 (SF-36) for health-related quality of life, Oswestry Disability Index (ODI), changes in opioid use and patient satisfaction were evaluated at baseline and 8 weeks after treatment.
Mean NRS scores were significantly lower at weeks 2, 4 and 8 compared to baseline (P < 0.001). There were significant improvements in SF-36 and ODI scores compared with pretreatment (P < 0.05). It was found that 31% and 13% of opioid users, respectively, discontinued and tapered off their opioid medication. 40% of patients were overall satisfied with the treatment.
In a cohort of patients with FBSS, caudal epidural PRF stimulation provided pain relief in 36% of treated subjects. Patients also experienced significant improvement in functionality, quality of life and opioid use. This technique can be considered as an alternative before considering neuromodulation, opiate therapy, or reoperation in patients with FBSS.
本研究的首要目的是调查超声引导下尾端硬膜外脉冲射频（PRF）刺激对腰椎手术失败综合征（FBSS）患者的镇痛效果；其次是评估对阿片类药物使用、功能障碍、生活质量和患者满意度的影响。
纳入30例因FBSS导致慢性腿痛病史超过6个月且数字评分量表（NRS）评分>4分的患者。这些患者对传统治疗反应不佳且至少接受过两次硬膜外类固醇注射。在超声引导下对尾端硬膜外间隙进行PRF刺激。在治疗前、干预后2周、4周和8周评估NRS。在基线和治疗后8周评估健康相关生活质量的简明健康状况调查量表（SF-36）、奥斯威斯功能障碍指数（ODI）、阿片类药物使用变化和患者满意度。
与基线相比，第2周、第4周和第8周时的平均NRS评分显著降低（P<0.001）。与治疗前相比，SF-36和ODI评分有显著改善（P<0.05）。发现分别有31%和13%的阿片类药物使用者停用和减少了阿片类药物用量。40%的患者对治疗总体满意。
在一组FBSS患者中，尾端硬膜外PRF刺激使36%的治疗对象疼痛得到缓解。患者在功能、生活质量和阿片类药物使用方面也有显著改善。在考虑对FBSS患者进行神经调节、阿片类药物治疗或再次手术之前，可将该技术视为一种替代方法。
