Triangular Stimulation Method Utilizing Combination Spinal Cord Stimulation With Peripheral Subcutaneous Field Stimulation for Chronic Pain Patients: A Retrospective Study
Triangular Stimulation Method Utilizing Combination Spinal Cord Stimulation With Peripheral Subcutaneous Field Stimulation for Chronic Pain Patients: A Retrospective Study
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DOI：
10.1111/j.1525-1403.2011.00422.x
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发表时间：
2012-03-01
期刊：
影响因子：
2.8
通讯作者：
Raso, Louis
中科院分区：
文献类型：
--
作者：
Navarro, Rosa M.;Vercimak, Danika C.;Raso, Louis
目的：本回顾性数据收集研究旨在评估使用脊髓刺激（SCS）和外周皮下野刺激（PSFS）结合的神经调节系统植入慢性难治性疼痛患者的反应。材料与方法：对40例同时植入SCS和PSFS导联的慢性难治性疼痛患者进行回顾性数据收集研究。比较植入前数据（人口统计、疼痛水平、疼痛位置和药物使用）和植入后数据（疼痛水平、药物使用和设备编程报告），以衡量大约六个月的短期和长期疼痛改善。收集了设备系统使用情况和参数数据。结果：通过SCS/PSFS联合治疗，大多数患者的疼痛得到了即时和短期的缓解，口服止痛药的用量减少。这种改善在一些病人身上维持了6个月，但不是所有的病人。患者在随访期间循环进行多个项目；随着时间的推移，三角刺激的使用是一致的，到六个月时，患者更喜欢这个项目。回顾性图表回顾的局限性包括缺少数据和随访时间的变化，这可能使确定长期疗效变得困难。结论：本研究表明，与基线相比，SCS和PSFS联合治疗对于减轻先前难治性慢性疼痛患者的疼痛水平和口服止痛药可能是一种有益的治疗选择。有必要在更多的研究对象和前瞻性、控制性环境中进一步研究这种疗法。根据笔者的一般经验，三角形刺激对于治疗孤立性腰痛是非常有效的，因为它比流场刺激覆盖了更大的下背部地形区域。一项试验性器械豁免研究将是必要的，以便医生在未来充分研究和利用针对局灶性孤立性疼痛的皮下野刺激。
Objectives: This retrospective data collection study aims to evaluate the responses of patients who have been implanted with a neuromodulation system using a combination of spinal cord stimulation (SCS) and peripheral subcutaneous field stimulation (PSFS) leads for chronic intractable pain.Materials and Methods: Forty patients with chronic, intractable pain implanted with both SCS and PSFS leads were enrolled in a retrospective data collection study. Pre-implant data (demographics, pain levels, pain location, and medication use) and post-implant data (pain levels, medication use, and device programming reports) were compared to measure short-and long-term improvements in pain for a period of approximately six months. Device system use and parameter data were collected.Results: The majority of patients experienced immediate and short-term pain relief and reduction in oral pain medications as a result of combination SCS/PSFS therapy. The improvements were maintained for some, but not all patients by six months. Patients cycled through multiple programs over follow-up; the use of triangular stimulation was consistent over time, and by six months, patients preferred this program over others. Limitations of the retrospective chart review included missing data and variable follow-up times, and may have made determinations of long-term efficacy difficult.Conclusions: This study demonstrates that combination SCS and PSFS therapy is potentially a beneficial treatment option for reducing pain levels and oral pain medication compared with baseline in previously resistive chronic pain patients. There is a need for further study of this therapy in a greater number of subjects and in a prospective, controlled setting. In the author's general experience, triangular stimulation is very effective for treating isolated low back pain, because it covers larger topographic areas of the lower back than flowor field stimulation. An investigational device exemption study will be necessary for subcutaneous field stimulation indicated for focal isolated pain to be adequately investigated and utilized by physicians in the future.