背景:背根神经节刺激(DRG-S)最近已成为神经调节的一种新疗法,在前瞻性研究中显示出比脊髓刺激(SCS)更高的成功率,治疗复杂区域疼痛综合征(CRPS)和灼痛的头对头随机比较试验。与SCS相比,DRG-S在治疗非纯粹神经性疾病如轴向下腰痛方面也显示出希望。有突出的伤害性疼痛成分。对于这样的适应症,DRG-S的有效性在多大程度上是由于神经性疼痛组分的有效治疗相对于DRG-S对机械疼痛的作用。虽然很少研究,报告DRG-S主要治疗机械性/伤害性疼痛的结局可能有助于扩大该疗法的效用.这里,我们介绍了5例用DRG-S治疗的难治性机械性疼痛。
方法:对2017年9月至2021年9月在我们研究所成功进行DRG-S试验和植入的所有患者进行了回顾性分析。该病例系列包括患有顽固性关节痛而没有强烈神经性疼痛证据的患者。CRPS的布达佩斯标准,Douleur神经病变4问题(DN4)调查,或明确的神经损伤被用来确定是否存在神经性疼痛。疼痛的基线评估(数字评定量表[NRS]),函数(Oswestry残疾指数[ODI]),生活质量(EuroQol-5维度[EQ-5D]),和其他适用的联合调查是从审前基线和后续预约中提取的。
结果:确定并纳入5例患者。患者的诊断包括顽固性髋关节疼痛,膝盖,或者脚踝.平均NRS疼痛评分从基线时的9.2提高到最后一次随访时的2.4,提高了74%(平均=植入后28个月)。从基线到最后一次随访,平均ODI得分从66提高到23,提高了65%,EQ-5D得分从平均0.371提高到0.797,提高了一倍以上.
结论:该临床报告说明了DRG-S在治疗疼痛方面的潜在效用,该疼痛在临床上表现为主要难治性机械性关节痛,而没有明显的神经病变成分。我们观察的生理原因可能是DRG-S能够直接影响DRG和脊髓内的伤害性信号传导。需要进一步研究以确定DRG-S是否是慢性机械性疼痛的潜在治疗选择。
Dorsal root ganglion stimulation (DRG-S) has recently emerged as a novel therapy in neuromodulation that demonstrated a higher rate of success than spinal cord stimulation (SCS) in a prospective, head-to-head randomized comparative trial to treat complex regional pain syndrome (CRPS) and causalgia. In contrast to SCS, DRG-S also shows promise in treating conditions that are not purely neuropathic such as axial low back pain, which has a prominent nociplastic pain component. It is not known to what extent the effectiveness of DRG-S for such indications is due to effective treatment of the neuropathic pain component versus the effects of DRG-S on mechanical pain. Although rarely studied, reporting outcomes of DRG-S to treat predominantly mechanical/nociceptive pain may help point toward expanding the utility of this therapy. Here, we present five cases of refractory mechanical pain treated with DRG-S.
A retrospective analysis of all patients who underwent a successful DRG-S trial and implant between September 2017 and September 2021 at our institute was performed. Patients who had intractable joint pain without strong evidence of neuropathic pain were included in this
case series. The Budapest criteria for CRPS, the Douleur Neuropathique 4 Questions (DN4) survey, or a definable nerve injury were used to determine the presence of neuropathic pain. Baseline assessments for pain (Numeric Rating Scale [NRS]), function (Oswestry Disability Index [ODI]), quality of life (EuroQol-5 Dimension [EQ-5D]), and other applicable joint surveys were extracted from pre-trial baseline and follow-up appointments.
Five patients were identified and included. Patient diagnoses consisted of refractory joint pain of the hip, knee, or ankle. Mean NRS pain scores improved by 74% from 9.2 at baseline to 2.4 at the last follow-up (mean = 28 months post-implant). From baseline to the last follow-up, mean ODI scores improved by 65% from 66 to 23 and EQ-5D scores more than doubled from an average of 0.371 to 0.797.
This clinical report illustrates the potential utility DRG-S has in treating pain that clinically presents as predominantly refractory mechanical joint pain without a significant neuropathic component. The physiological reasons for our observations may be that DRG-S is able to directly influence the conduction of nociceptive signaling at the DRG and within the spinal cord. Further investigations are warranted to determine if DRG-S is a potential treatment option for chronic mechanical pain.