The Appropriate Use of Neurostimulation of the Spinal Cord and Peripheral Nervous System for the Treatment of Chronic Pain and Ischemic Diseases: The Neuromodulation Appropriateness Consensus Committee
The Appropriate Use of Neurostimulation of the Spinal Cord and Peripheral Nervous System for the Treatment of Chronic Pain and Ischemic Diseases: The Neuromodulation Appropriateness Consensus Committee
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DOI：
10.1111/ner.12208
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发表时间：
2014-08-01
期刊：
影响因子：
2.8
通讯作者：
North, Richard
中科院分区：
文献类型：
--
作者：
Deer, Timothy R.;Mekhail, Nagy;North, Richard
简介：神经调节适当共识委员会（NACC）的国际神经调节学会（INS）评估证据的安全性和有效性的神经刺激治疗慢性疼痛，慢性严重肢体缺血，难治性心绞痛，并建议适当的临床applications.Methods：NACC采用文献综述，专家意见，临床经验，和个人研究。作者查阅了《脊髓刺激治疗神经性疼痛的实践参数》（2006年）、系统综述（1984年至2013年）以及通过PubMed、EMBASE和Google Scholar识别的前瞻性和随机对照试验（2005年至2013年）。结果：神经刺激因其微创和可逆特性而相对安全。由于考虑神经刺激的患者保守治疗失败，因此难以与医疗管理进行比较。与替代疗法不同，神经刺激与药物相关的副作用无关，并且具有持久的效果。器械相关并发症并不少见;然而，随着技术进步和手术技能的提高，其发生率正在降低。随机对照研究支持脊髓电刺激治疗腰椎手术失败综合征和复杂性区域疼痛综合征的疗效。需要对周围神经性疼痛、截肢后疼痛、带状疱疹后神经痛和其他神经损伤原因的神经刺激进行类似的研究。国际指南建议脊髓刺激治疗难治性心绞痛;其他适应症，如充血性心力衰竭，正在调查。结论：适当的神经刺激是安全和有效的，在一些慢性疼痛条件。技术改进和临床证据将继续扩大其使用。NACC旨在促进神经刺激的有效性和安全性。
Introduction: The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications.Methods: The NACC used literature reviews, expert opinion, clinical experience, and individual research. Authors consulted the Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Neuropathic Pain (2006), systematic reviews (1984 to 2013), and prospective and randomized controlled trials (2005 to 2013) identified through PubMed, EMBASE, and Google Scholar.Results: Neurostimulation is relatively safe because of its minimally invasive and reversible characteristics. Comparison with medical management is difficult, as patients considered for neurostimulation have failed conservative management. Unlike alternative therapies, neurostimulation is not associated with medication-related side effects and has enduring effect. Device-related complications are not uncommon; however, the incidence is becoming less frequent as technology progresses and surgical skills improve. Randomized controlled studies support the efficacy of spinal cord stimulation in treating failed back surgery syndrome and complex regional pain syndrome. Similar studies of neurostimulation for peripheral neuropathic pain, postamputation pain, postherpetic neuralgia, and other causes of nerve injury are needed. International guidelines recommend spinal cord stimulation to treat refractory angina; other indications, such as congestive heart failure, are being investigated.Conclusions: Appropriate neurostimulation is safe and effective in some chronic pain conditions. Technological refinements and clinical evidence will continue to expand its use. The NACC seeks to facilitate the efficacy and safety of neurostimulation.