Odonkor Charles A, Oghenesume Oghenewoma, Hirani Salman, Bohacek Siri, Gutierrez David E, Sekhar Rajat, McCormick Zachary L, Poree Lawrence, Abd-Elsayed Alaa
Department of Orthopaedics and Rehabilitation, Division of Physiatry, Interventional Pain Medicine, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT, USA.
Yale University School of Medicine, New Haven, CT, USA.
J Pain Res. 2025 Aug 8;18:3963-3976. doi: 10.2147/JPR.S524870. eCollection 2025.
Clinical predictors of pain relief with 60-day peripheral nerve stimulation (PNS) remained undefined. Identifying the factors associated with treatment outcomes may improve patient selection and optimize results.
This study examined baseline physical activity, pain, disability, and psychological factors influencing early versus delayed response and non-response to a 60-day PNS.
A prospective, multicenter, observational cohort study was conducted on 73 patients who consecutively received a 60-day PNS. Baseline assessments included pain (numeric rating scale [NRS]), disability (Oswestry Disability Index [ODI]), psychological profiles (Pain Self-Efficacy Questionnaire, PSEQ; Pain Catastrophizing Scale, PCS), and physical activity (physical activity vital signs [PAVS]). Logistic regression and principal component analysis were used to identify the predictors of response phenotypes.
Early (≥50% pain relief within 7-14 days of PNS implant that is sustained through the entire 60-day period) and delayed (<50% pain relief in the first 14 days but eventually reaching ≥50% before the end of the 60 days) responder rates were 26% and 43%, respectively. Non-responders (<50% pain relief at the end of the 60-day treatment period) comprised 30.1% of the group. Predictors of early response included high physical activity (OR=4.22, p=0.0006, Area Under the Curve [AUC] =0.81), high pain self-efficacy (OR=1.12, p=0.0004, AUC=0.86), and low catastrophizing (OR=0.88, p=0.0003, AUC=0.86). A delayed response was associated with a longer chronic pain duration (OR=0.83, p=0.027) and high baseline ODI (OR=0.43, p=0.002; AUC=0.79). Nonresponse was linked to psychological distress (eigenvalue =3.23, 40.3% variance), opioid dependency, and morbid obesity (eigenvalue =1.63, 20.4% variance).
This real-world study showed that baseline physical activity, psychological resilience, and pain behaviors predicted response to a 60-day PNS. Non-responders presented with psychological distress, morbid obesity, and opioid dependence. These findings may refine patient selection and help to set treatment expectations for 60-day PNS.
60天外周神经刺激（PNS）实现疼痛缓解的临床预测因素仍不明确。确定与治疗结果相关的因素可能会改善患者选择并优化治疗效果。
本研究探讨了影响60天PNS早期与延迟反应及无反应的基线身体活动、疼痛、功能障碍和心理因素。
对73例连续接受60天PNS的患者进行了一项前瞻性、多中心、观察性队列研究。基线评估包括疼痛（数字评定量表[NRS]）、功能障碍（奥斯威斯功能障碍指数[ODI]）、心理状况（疼痛自我效能问卷，PSEQ；疼痛灾难化量表，PCS）和身体活动（身体活动生命体征[PAVS]）。采用逻辑回归和主成分分析来确定反应表型的预测因素。
早期反应者（PNS植入后7 - 14天内疼痛缓解≥50%，并在整个60天期间持续）和延迟反应者（前14天疼痛缓解<50%，但在60天结束前最终达到≥50%）的比例分别为26%和43%。无反应者（60天治疗期结束时疼痛缓解<50%）占该组的30.1%。早期反应的预测因素包括高身体活动（OR = 4.22，p = 0.0006，曲线下面积[AUC] = 0.81）、高疼痛自我效能（OR = 1.12，p = 0.0004，AUC = 0.86）和低灾难化程度（OR = 0.88，p = 0.0003，AUC = 0.86）。延迟反应与更长的慢性疼痛持续时间（OR = 0.83，p = 0.027）和高基线ODI（OR = 0.43，p = 0.002；AUC = 0.79）相关。无反应与心理困扰（特征值 = 3.23，方差40.3%）、阿片类药物依赖和病态肥胖（特征值 = 1.63，方差20.4%）有关。
这项真实世界研究表明，基线身体活动、心理复原力和疼痛行为可预测60天PNS的反应。无反应者表现出心理困扰、病态肥胖和阿片类药物依赖。这些发现可能会优化患者选择，并有助于设定60天PNS的治疗预期。
