克罗恩病是一种慢性炎症性肠病引起的症状,尤其是疼痛,由于持续的肠道炎症或脓肿等并发症,狭窄,和瘘管,这在IBD患者中很常见。腹痛影响高达60%的IBD患者,不管疾病的严重程度,促使医疗护理。各种药物如NSAIDs,抗抑郁药,抗痉挛药,抗惊厥药,阿片类药物用于控制疼痛,但是它们的有效性和潜在的副作用有限,甚至在缓解期间。在这种情况下,一名20岁的白人女大学生[身高5'4”,体重120磅(54.4公斤)]青少年特发性关节炎和克罗恩病每天经历严重的腹痛,对她的生活产生负面影响。尽管采用了多模式方案,包括加巴喷丁,nortriptyline,度洛西汀,和对乙酰氨基酚,她的痛苦持续,严重影响了她的食欲,睡眠,心情,活动水平,和整体生活质量(QOL)。为了解决这个问题,考虑刺激背根神经节(DRG)。患者的目标是减少20%的疼痛并改善生活质量。试验导线沿T10和T12DRG放置,导致25%的疼痛减少(10个中的8-6个)和显著的生活质量改善。她可以吃,睡眠没有中断,走更长的距离,并且更加活跃。T12导联比T10导联更有效,针对上腹部刺激。患者和她的母亲非常满意,并选择了T11和T12DRG的永久性植入。虽然DRG刺激在2016年被批准用于慢性疼痛,根据我们的知识,这是该药物在患有虚弱性克罗恩病的患者中使用的首例报道。
Crohn\'s disease is a chronic inflammatory bowel condition causing symptoms, notably pain, due to ongoing intestinal inflammation or complications like abscesses, strictures, and fistulas, which are common in
IBD patients. Abdominal pain affects up to 60 % of
IBD patients, irrespective of disease severity, prompting medical attention. Various medications like NSAIDs, antidepressants, antispasmodics, anticonvulsants, and opioids are used to manage pain, but they have limited effectiveness and potential side effects, even during remission. In this case, a 20-year-old Caucasian female college student [height 5\'4″, weight 120lbs (54.4 kg)] with juvenile idiopathic arthritis and Crohn\'s disease experienced severe daily abdominal pain, negatively impacting her life. Despite a multimodal regimen, including gabapentin, nortriptyline, duloxetine, and acetaminophen, her pain persisted, significantly affecting her appetite, sleep, mood, activity level, and overall quality of life (QOL). To address this, dorsal root ganglion (DRG) stimulation was considered. The patient aimed for a 20 % pain reduction and improved QOL. Trial leads were placed along the T10 and T12 DRG, resulting in a 25 % pain reduction (8-6 out of 10) and substantial QOL improvement. She could eat, sleep without interruptions, walk longer distances, and be more active. The T12 lead was more effective than the T10, targeting upper abdomen stimulation. The patient and her mother were highly satisfied and opted for permanent implantation for the T11 and T12 DRG. While DRG stimulation was approved in 2016 for chronic pain, to our knowledge, this is the first reported case of its use in a patient with debilitating Crohn\'s disease.