Subcutaneous Target Stimulation (STS) in Chronic Noncancer Pain: A Nationwide Retrospective Study
Subcutaneous Target Stimulation (STS) in Chronic Noncancer Pain: A Nationwide Retrospective Study
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DOI：
10.1111/j.1533-2500.2009.00351.x
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发表时间：
2010-07-01
期刊：
影响因子：
2.6
通讯作者：
Likar, Rudolf
中科院分区：
文献类型：
--
作者：
Sator-Katzenschlager, Sabine;Fiala, Katharina;Likar, Rudolf
刺激初级传入神经元为控制局部慢性疼痛提供了一种新方法。我们描述了一种新的神经刺激技术，皮下靶刺激（STS），用于治疗慢性局灶性非癌性疼痛的结果。STS通过经皮放置的皮下导线直接在疼痛区域施加永久性电刺激。我们报告了111例局灶性慢性非癌性疼痛患者接受STS治疗的临床结果，这是第一次全国性的多中心回顾性分析。STS的适应症为腰痛（n = 29）和背部手术失败综合征（背痛伴腿痛）（n = 37）、颈部疼痛（n = 15）和带状疱疹后神经痛（n = 12）。在植入前和植入后，采用数字评定量表（NRS）测量疼痛强度。从患者记录中获得有关镇痛药物、刺激系统、位置和电极导线类型以及并发症的数据。植入后，整个患者组的平均疼痛强度改善超过50%（平均NRS从8.2降至4.0）（P = 0.0009）。与此同时，止痛剂的需求持续减少。在所有患者中，STS电极导线直接定位在最大疼痛部位。14例患者（13%）发生电极导线脱位，7例患者（6%）发生感染，6例患者（5%）发生电极导线断裂。回顾性数据分析显示，STS有效地缓解了患有难治性局灶性慢性非癌性疼痛的患者的疼痛，STS是一种替代治疗选择。需要前瞻性对照研究来证实这些回顾性发现。本文介绍了一种治疗难治性局灶性疼痛的新微创技术。
Stimulation of primary afferent neurons offers a new approach for the control of localized chronic pain. We describe the results with a new neurostimulation technique, subcutaneous target stimulation (STS), for the treatment of chronic focal noncancer pain. STS applies permanent electrical stimulation directly at the painful area via a percutaneous-placed subcutaneous lead. We reported the clinical outcomes of 111 patients with focal chronic, noncancer pain treated with STS in this first nationwide, multicenter retrospective analysis. The indications for STS were low back pain (n = 29) and failed back surgery syndrome (back pain with leg pain) (n = 37), cervical neck pain (n = 15), and postherpetic neuralgia (n = 12). Pain intensity was measured on a numerical rating scale (NRS) before and after implantation. Data on analgesic medication, stimulation systems, position, and type of leads and complications were obtained from the patients' records. After implantation, the mean pain intensity improved by more than 50% (mean NRS reduction from 8.2 to 4.0) in the entire patient group (P = 0.0009). This was accompanied by a sustained reduction in demand for analgesics. In all the patients, the STS leads were positioned directly at the site of maximum pain. Lead dislocation occurred in 14 patients (13%), infections in 7 (6%), and in 6 cases (5%), lead fractures were observed. The retrospective data analysis revealed that STS effectively provided pain relief in patients suffering from refractory focal chronic noncancer pain and that STS is an alternative treatment option. Prospective controlled studies are required to confirm these retrospective findings. This article presents a new minimally invasive technique for therapy-resistant focal pain.