Matis Georgios, Chen Lilly, Jain Roshini, Doan Que
University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany.
Boston Scientific, Valencia, CA, USA.
Interv Pain Med. 2022 Dec 1;1(4):100165. doi: 10.1016/j.inpm.2022.100165. eCollection 2022 Dec.
A significant proportion of patients with chronic pain exhibit mixed pain and thus do not display symptoms exclusively associated with either nociceptive or neuropathic pain syndromes. We aimed to explore whether Fast-Acting Sub-Perception Therapy, FAST - a new Spinal Cord Stimulation (SCS)-based approach capable of inducing a rapid-onset of analgesia using electrical neurostimulation applied below patient-perception threshold - could potentially be useful as a treatment for chronic mixed pain.
Fourteen consecutively-enrolled patients diagnosed with chronic mixed pain and implanted with an SCS device were enrolled in this single-center case-series. All patients completed a validated, self-administered painDETECT questionnaire prior to SCS-device implantation (baseline). The painDETECT questionnaire was used to characterize each patient's chronic pain as likely neuropathic only, uncertain (but potential for presence of a non-neuropathic component), or likely presence of a non-neuropathic component. Overall pain scores (Numeric Rating Scale, NRS), Oswestry Disability Index (ODI) and Quality-of-life (EQ-5D-5L) were collected (per standard-of-care) at baseline, 3-months, and 6-months post-implantation.
The average age of those assessed in this study was 64.7 ± 11.5 (SD) years and 43% (6/14) were female. Fifty-percent (7/14) of patients were classified with non-neuropathic pain (painDETECT), while the remainder exhibited chronic pain that could not be characterized as either neuropathic or non-neuropathic (uncertain). Mean overall pain (NRS) among all patients was 8.3 ± 0.3 (SE) at baseline. At 6-months post-implant, a mean 6.9-points NRS score reduction was observed (1.4 ± 0.3 (SE); p < 0.0001). Notable improvements in disability (ODI) and Quality of Life (EQ-5D-5L) were also observed at 6-month follow-up.
The data from this observational case-series indicate that FAST-SCS can improve outcomes in patients reporting complex symptoms of mixed pain with a likely non-neuropathic component. These results suggest that neurostimulation modalities such as FAST may be a suitable treatment approach for non-neuropathic pain indications.
相当一部分慢性疼痛患者表现为混合性疼痛，因此不会仅表现出与伤害性疼痛或神经性疼痛综合征相关的症状。我们旨在探讨快速起效的亚感知疗法（FAST）——一种基于脊髓刺激（SCS）的新方法，能够使用低于患者感知阈值的电神经刺激诱导快速起效的镇痛——是否有可能作为慢性混合性疼痛的一种治疗方法。
本单中心病例系列研究纳入了14例连续入选的被诊断为慢性混合性疼痛并植入了SCS设备的患者。所有患者在植入SCS设备前（基线）完成了一份经过验证的、自我管理的疼痛DETECT问卷。疼痛DETECT问卷用于将每位患者的慢性疼痛特征化为仅可能是神经性的、不确定（但可能存在非神经性成分）或可能存在非神经性成分。在基线、植入后3个月和6个月时（按照标准护理）收集总体疼痛评分（数字评定量表，NRS）、Oswestry功能障碍指数（ODI）和生活质量（EQ - 5D - 5L）。
本研究中接受评估的患者平均年龄为64.7±11.5（标准差）岁，43%（6/14）为女性。50%（7/14）的患者被归类为非神经性疼痛（疼痛DETECT），其余患者表现为无法被表征为神经性或非神经性的慢性疼痛（不确定）。所有患者在基线时的平均总体疼痛（NRS）为8.3±0.3（标准误）。在植入后6个月时，观察到NRS评分平均降低了6.9分（1.4±0.3（标准误）；p<0.0001）。在6个月随访时还观察到功能障碍（ODI）和生活质量（EQ - 5D - 5L）有显著改善。
这个观察性病例系列的数据表明，FAST - SCS可以改善报告有混合性疼痛且可能有非神经性成分的复杂症状患者的治疗效果。这些结果表明，像FAST这样的神经刺激方式可能是治疗非神经性疼痛适应症的一种合适方法。
