Abstract

BACKGROUND

Spinal cord stimulation (SCS) is an effective treatment in chronic neuropathic pain, but its efficacy in complex regional pain syndrome (CRPS) needs to be proven.

OBJECTIVE

To study the outcome of SCS in CRPS as measured by trial success, explantation rate, complications, and changes in opioid and neuropathic pain medication use over a 4-yr follow-up.

METHODS

We retrospectively reviewed all medical records of 35 consecutive CRPS patients who underwent SCS trials at 2 hospitals during January 1998 to December 2016. The purchase data of opioids and neuropathic pain medication during January 1995 to March 2016 were retrieved from national registries.

RESULTS

Based on a 1-wk trial, permanent SCS was implanted in 27 (77%) patients. During the median follow-up of 8 yr, 8 (30%) SCS devices were explanted, of which 7 were because of inefficient pain relief. Complications leading to revision occurred in 17 (63%) patients: 8 electrode migrations or stimulation to the wrong area, 1 deep infection, 9 hardware malfunctions, 2 pulse generator discomforts, and 2 SCS replacements. None of the 6 patients using strong opioids discontinued their use during the 2-yr follow-up. The mean opioid dose increased nonsignificantly both in patients with SCS in permanent use (53 ± 150 morphine milligram equivalents morphine milligram equivalent (MME)/day to 120 ± 240 MME/day) and in patients who had SCS explanted (27 ± 72 MME/day to 57 ± 66 MME/day).

CONCLUSION

Despite the fact that CRPS patients were not able to discontinue or reduce their strong opioid or neuropathic pain medication use, 70% continued to use their SCS device during a median 8-yr follow-up.

中文翻译：

---

复杂区域疼痛综合征脊髓刺激的长期结果

摘要

背景

脊髓刺激 (SCS) 是治疗慢性神经性疼痛的有效方法，但其对复杂区域疼痛综合征 (CRPS) 的疗效有待证实。

客观的

研究 SCS 在 CRPS 中的结果，通过试验成功、外植率、并发症以及 4 年随访中阿片类药物和神经性止痛药使用的变化来衡量。

方法

我们回顾性地回顾了1998年1月至2016年12月期间在2家医院接受SCS试验的35例连续CRPS患者的所有病历。从国家登记处检索了1995年1月至2016年3月期间阿片类药物和神经性止痛药的购买数据。

结果

根据一项为期 1 周的试验，27 名 (77%) 患者植入了永久性 SCS。在 8 年的中位随访期间，移植了 8 个（30%）SCS 装置，其中 7 个是因为疼痛缓解无效。17 名 (63%) 患者出现导致翻修的并发症：8 次电极迁移或刺激到错误区域、1 次深度感染、9 次硬件故障、2 次脉冲发生器不适和 2 次 SCS 更换。在 2 年随访期间，使用强阿片类药物的 6 名患者均未停止使用。永久使用的 SCS 患者（53 ± 150 吗啡毫克当量（MME）/天至 120 ± 240 MME/天）和 SCS 移植患者（27 ± 72 MME/天）的平均阿片类药物剂量增加不显着57 ± 66 MME/天）。

结论

尽管 CRPS 患者无法停止或减少其强效阿片类药物或神经性止痛药的使用，但 70% 的患者在中位 8 年随访期间继续使用其 SCS 设备。