短时程脊髓电刺激治疗爆发痛合并触诱发痛的急性期带状疱疹的临床研究

Efficacy of temporary spinal cord stimulation in the treatment of breakthrough pain and allodynia of acute herpetic neuralgia

关键词:  带状疱疹神经痛  脊髓电刺激  爆发痛  触诱发痛

Key words:  acute herpetic neuralgia  spinal cord stimulation  breakthrough pain  allodynia

摘要:

目的探讨短时程脊髓电刺激(temporary spinal cord stimulation, tSCS)治疗爆发痛合并触诱发痛的急性期带状疱疹的临床疗效。方法回顾性地分析同济大学附属第十人民医院疼痛科2020年1月—2020年12月收治的52例接受tSCS治疗的爆发痛合并触诱发痛的急性期带状疱疹患者的临床资料，评估在治疗前、治疗后3d、7d、14d、3个月、6个月的总体疼痛情况(numerical rating scale, NRS)评分、(simple McGill scores, McGill)评分、爆发痛情况(发生率、NRS评分、次数以及持续时间)、触诱发痛情况(发生率、分级)、术后不良反应等；评估在治疗前、治疗后7d、3个月、6个月的睡眠时长、睡眠中醒来次数、疼痛障碍指数(pain disorder index, PDI)、功能状态评分(Karnofsky score, KPS)、抑郁症筛查量表(patient health questionnaire depression module scale, PHQ-9)和焦虑症筛查量表(generalized anxiety disorder-7 scale, GAD-7)等。结果与治疗前相比，治疗后3d、7d、14d、3个月、6个月的总体疼痛NRS评分、总体疼痛MCGILL评分、静息痛NRS评分明显降低(均P<0.001)；与治疗前相比，治疗后3d、7d、14d、3个月、6个月的的爆发痛NRS评分明显降低(均P<0.05)，治疗后14d、3个月、6个月时的爆发痛次数以及持续时间都明显降低(均P<0.05)；与治疗前比较，患者治疗后7d、14d、3个月、6个月时的触诱发痛的分级都明显降低，差异均有统计学意义(均P<0.05)；与治疗前相比，治疗后14d、3个月、6个月的PDI评分明显降低(P<0.05)；与治疗前相比，治疗后14d、3个月、6个月的PHQ-9评分和GAD-7评分都明显减少(P<0.05)，与术前的药物使用情况相比，治疗后各镇痛药使用人数普遍呈下降趋势；术中及整个随访期间未观察到严重不良事件。结论短时程脊髓电刺激对爆发痛合并触诱发痛的急性期带状疱疹具有较好的临床疗效。

Abstract:

ObjectiveTo evaluate the clinical efficacy of temporary spinal cord stimulation(tSCS) in the treatment of breakthrough pain(BTP) and allodynia of acute herpetic neuralgia. MethodsThe clinical data of 52 patients diagnosed with BTP and allodynia of acute herpetic neuralgia, who were treated with tSCS in our department from January 2020 to December 2020 were retrospectively analyzed. The numerical rating scale(NRS) and McGill score of overall pain; the incidence, NRS, frequency and duration of BTP; the incidence, grade of allodynia, the adverse reactions were evaluated before treatment and 3d,7d, 14d, 3 months, 6 months after treatment. The Pitsburgh sleep quality index(PSQI) scores, pain disorder index(PDI), Karnofsky scale(KPS), Patient Health Questionnaire depression module scale(PHQ-9) and Generalized anxiety disorder-7 scale(GAD-7) were used to evaluate the clinical efficacy before treatment, and 7d, 3 months, 6 months after the treatment. ResultsCompared with those before treatment, the scores of overall pains(NRS and McGill scores) and resting pain(NRS scores) were significantly decreased at 3d, 7d, 14d, 3 months, and 6 months after treatment(P<0.001). Compared with those before treatment, the NRS of BTP was significantly decreased and the duration of BTP was shortened at 3d, 7d, 14d, 3 months, and 6 months after treatment(P<0.05). Compared with those before treatment, the grade of allodynia pain at 7d, 14 days, 3 months and 6 months after treatment was significantly reduced(P<0.05). The PDI scores were significantly decreased 14d, 3 months and 6 months after treatment(P<0.001). The PHQ-9 scores and GAD-7 scores at 14d, 3months and 6 months after treatment were significantly lower than those before treatment(P<0.05). The proportion of patients using analgesic drugs dshowed a downward trend after treatment. No significant adverse events were observed perioperatively and during the follow-up. ConclusionTemporary spinal cord stimulation is effective and safe in treatment of BTP and allodynia in patients with acute herpetic neuralgia.