Vu Peter D, Mach Steven, Javed Saba
Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
Department of Pain Medicine, Division of Anesthesiology, Critical Care & Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Neuromodulation. 2025 Feb;28(2):191-203. doi: 10.1016/j.neurom.2024.10.006. Epub 2024 Nov 25.
Cancer pain is among the most prevalent and challenging symptoms in cancer care, with up to 95% of patients with late-stage cancer experiencing moderate-to-severe pain. Conventional pharmacologic treatments, including opioids, carry risks, and patients' conditions may be refractory to medical management or have contraindications. Neurostimulation techniques, such as spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRGS), and peripheral nerve stimulation (PNS), have shown promise in treating treatment-induced cancer pain. However, a comprehensive review focusing on these techniques for cancer-induced pain alone is necessary.
A comprehensive literature review was conducted using Medline, Embase, and Cochrane Library data bases, focusing on studies from 2000 onward. Inclusion criteria included interventional and observational studies reporting on SCS, DRGS, and PNS in cancer-induced pain. Studies addressing treatment-induced pain, systematic reviews, meta-analyses, and non-English studies were excluded. Data were extracted and evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation system.
The search yielded 831 references, with 24 studies meeting the inclusion criteria. Sixteen studies focused on SCS, seven on PNS, and two cases on DRGS. SCS showed significant pain reduction, with an average decrease in numeric rating scale (NRS) scores from 8.0 to 2.2 over an average 8.4-month follow-up period. PNS also indicated substantial pain relief, with NRS scores decreasing from 8.29 to 3.04 over an average 5.2-month follow-up period. DRGS, although less studied, showed a reduction in NRS scores from 6.0 to 1.0 over an average 6.0-month follow-up period. SCS was associated with a significant reduction in opioid use, with average reported morphine equivalent daily dose (MEDD) change from 1152.2 mg to 739.7 mg over an average 5.0-month period, whereas PNS and DRGS had limited impact on opioid consumption, with no reported MEDD change.
Our scoping review synthesizes evidence on neurostimulation interventions for treating cancer-induced pain. Current evidence suggests that interventions such as SCS, DRGS, and PNS may provide clinically meaningful pain relief in patients with cancer-induced pain. Several studies also reported improvements in functionality and quality of life. However, the level of evidence is limited owing to the lack of prospective comparative studies, clinical and methodologic heterogeneity, and small sample sizes.
癌症疼痛是癌症护理中最常见且最具挑战性的症状之一，高达95%的晚期癌症患者经历中度至重度疼痛。包括阿片类药物在内的传统药物治疗存在风险，且患者的病情可能对药物治疗无效或存在禁忌证。神经刺激技术，如脊髓刺激（SCS）、背根神经节刺激（DRGS）和周围神经刺激（PNS），在治疗治疗引起的癌症疼痛方面已显示出前景。然而，有必要单独针对这些技术治疗癌症引起的疼痛进行全面综述。
使用Medline、Embase和Cochrane图书馆数据库进行全面的文献综述，重点关注2000年以后的研究。纳入标准包括关于SCS、DRGS和PNS治疗癌症引起疼痛的干预性和观察性研究。涉及治疗引起的疼痛、系统评价、荟萃分析和非英文研究的排除。使用推荐分级、评估、制定和评价系统提取和评估数据。
检索得到831篇参考文献，24项研究符合纳入标准。16项研究聚焦于SCS，7项聚焦于PNS，2项病例研究聚焦于DRGS。SCS显示疼痛显著减轻，在平均8.4个月的随访期内，数字评分量表（NRS）得分平均从8.0降至2.2。PNS也显示出显著的疼痛缓解，在平均5.2个月的随访期内，NRS得分从8.29降至3.04。DRGS虽然研究较少，但在平均6.0个月的随访期内，NRS得分从6.0降至1.0。SCS与阿片类药物使用显著减少相关，在平均5.0个月的时间里，报告的平均吗啡当量日剂量（MEDD）从1152.2毫克变为739.7毫克，而PNS和DRGS对阿片类药物消耗的影响有限，未报告MEDD变化。
我们的范围综述综合了关于神经刺激干预治疗癌症引起疼痛的证据。目前的证据表明，SCS、DRGS和PNS等干预措施可能为癌症引起疼痛的患者提供具有临床意义的疼痛缓解。几项研究还报告了功能和生活质量的改善。然而，由于缺乏前瞻性比较研究、临床和方法学异质性以及样本量小，证据水平有限。
