The US government and other key stakeholders including professional medical bodies have amended recommendations in recent years to emphasize using no opioids or the lowest effective dose of opioids needed for treatment of chronic pain. However, there remains an unmet need for pain treatments that can both relieve the pain of patients and reduce the doses of opioids they require. The Center for Medicare and Medicaid Services (CMS) is currently considering such treatments through the SUPPORT ACT and has recently conferred with the Health and Human Services (HHS) Inter-agency Pain Management Task Force to consider such therapies. We reviewed literature evidence in PubMed on pain relief and opioid reduction following spinal cord stimulation (SCS) treatment. SCS presents an effective non-pharmacologic pain treatment modality that has been used for decades to reduce chronic pain from trauma or neuropathy and has been shown to either stabilize or reduce opioid use in some patients with painful conditions. A more recently developed high-frequency SCS modality, 10 kHz SCS, has the advantage of being paresthesia-independent. It has been shown to be associated with significant reductions in opioid consumption after stimulation therapy was initiated, and many patients even taking high doses of opioids (> 90 mg morphine equivalent dose per day) were able to reduce their opioid intake to levels associated with less risk. The evidence shows that reduction of opioids as early in the treatment process as possible is desirable to reduce patient risk and improve pain relief from stimulation therapy.

中文翻译：

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在阿片类药物流行中，通过脊髓刺激治疗改善慢性疼痛患者的护理。

近年来，美国政府和其他主要利益相关者，包括专业医疗机构，已对建议进行了修订，以强调不使用阿片类药物或使用阿片类药物的最低有效剂量来治疗慢性疼痛。然而，仍然需要缓解疼痛的疗法，该疗法既可以减轻患者的痛苦，又可以减少他们所需的阿片类药物的剂量。医疗保险和医疗补助中心（CMS）目前正在通过支持法案（SUPPORT ACT）考虑此类治疗，并且最近已委托卫生与公共服务（HHS）机构间疼痛管理工作组审议此类治疗。我们回顾了PubMed中有关脊髓刺激（SCS）治疗后疼痛缓解和阿片类药物减少的文献证据。SCS提供了一种有效的非药物性疼痛治疗方法，这种方法已用于减轻创伤或神经病引起的慢性疼痛已有数十年之久，并且已被证明可以稳定或减少某些疼痛情况下的阿片类药物的使用。最近开发的高频SCS模态10 kHz SCS具有与感觉异常无关的优势。已经表明，在开始刺激治疗后，阿片类药物的消耗量显着减少，许多患者甚至服用高剂量的阿片类药物（每天服用90毫克吗啡当量）也能将阿片类药物的摄入量降低至与减少阿片类药物相关的水平。风险。证据表明，在治疗过程中尽早减少阿片类药物对降低患者风险和改善刺激疗法的止痛效果是理想的。