Saengsomsuan Niruji, Euasobhon Pramote, Sitthinamsuwan Bunpot, Saisavoey Nattha, Li Caixia, Zinboonyahgoon Nantthasorn
Department of Anesthesiology, Thammasat University Hospital, Thammasat University, Thailand.
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
Pain Physician. 2025 Jan;28(1):E61-E71.
Evidence of the efficacy of spinal cord stimulation (SCS) has been well demonstrated as a method of pain control for patients who exhibit failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), and inoperable peripheral vascular diseases (PVD) ("usual indications"). However, a long-term study comparing the usual indications for which SCS is employed with those of other intractable painful conditions is still lacking.
To assess the long-term effectiveness of SCS treatment for both usual and unusual indications.
Observational study and original research.
This work was conducted at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
We recruited patients undergoing SCS treatment for chronic refractory pain caused by various conditions and followed up on those patients for up to 36 months. The patients were divided into usual indications for SCS, including FBSS, CRPS, and PVD; and unusual indications for SCS, including chronic refractory neuropathic pain of various etiologies. Pain intensity, pain-related interference, and health-related quality of life (HRQOL) were collected at the baseline, 6 months, and one, 2, and 3 years after SCS implantation, and the values seen at each time point were compared to the baseline values.
Forty-six patients were recruited, 30 of whom underwent successful SCS implantation (24 usual and 6 unusual indications). The overall pain intensity was significantly lower than it was at the baseline, decreasing from 6 to 3, 5, 4, 4 out of 10 at 6, 12, 24 and 36 months after implantation, respectively (P < 0.01). Pain-related interference and HRQOL tended to improve over time after implantation. Patients with usual indications had a significantly higher rate of trial-per-implant ratio than those with unusual indications, with an odd ratio of 5.14 (95% CI 1.36-19.50). Furthermore, patients with usual indications tended to see greater improvement and more constancy in pain intensity, pain-related interference, and HRQOL than those with unusual indications.
This analysis was a single-center prospective study with a nonrandomized design and a relatively small sample size.
Overall, SCS is an effective long-term treatment for chronic refractory pain. However, patients with usual indications for SCS have a higher success rate in SCS trials and a trend toward better outcomes after SCS implantation than do patients with unusual indications.
脊髓刺激（SCS）作为一种治疗方法，其疗效已在表现出腰椎手术失败综合征（FBSS）、复杂性区域疼痛综合征（CRPS）和无法手术的外周血管疾病（PVD）（“常见适应症”）的患者的疼痛控制中得到充分证明。然而，一项将SCS应用的常见适应症与其他顽固性疼痛病症进行比较的长期研究仍然缺乏。
评估SCS治疗常见和不常见适应症的长期有效性。
观察性研究和原创性研究。
这项工作在泰国玛希隆大学诗里拉吉医院医学院进行。
我们招募了因各种病症接受SCS治疗的慢性顽固性疼痛患者，并对这些患者进行了长达36个月的随访。患者被分为SCS的常见适应症，包括FBSS、CRPS和PVD；以及SCS的不常见适应症，包括各种病因引起的慢性顽固性神经性疼痛。在SCS植入前的基线、植入后6个月、1年、2年和3年收集疼痛强度、疼痛相关干扰和健康相关生活质量（HRQOL），并将每个时间点的值与基线值进行比较。
招募了46名患者，其中30名成功植入SCS（24名常见适应症和6名不常见适应症）。总体疼痛强度明显低于基线水平，分别在植入后6个月、12个月、24个月和36个月时从10分中的6分降至3分、5分、4分和4分（P<0.01）。植入后，疼痛相关干扰和HRQOL随时间推移有改善趋势。常见适应症患者的每次植入试验成功率明显高于不常见适应症患者，比值比为5.14（95%CI 1.36-19.50）。此外，与不常见适应症患者相比，常见适应症患者在疼痛强度、疼痛相关干扰和HRQOL方面往往有更大改善且更稳定。
本分析是一项单中心前瞻性研究，采用非随机设计且样本量相对较小。
总体而言，SCS是治疗慢性顽固性疼痛的有效长期疗法。然而，与不常见适应症患者相比，SCS常见适应症患者在SCS试验中的成功率更高，且植入SCS后有更好预后的趋势。
