【原】【晨读】脊髓电刺激（一）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自ROCK AK , Truong H , Park YL, et al. Spinal Cord Stimulation[J]. Neurosurg Clin N Am, 2019, 30(2):169-194.本次学习由谢珺田副主任医师主讲。

KEYWORDS 

Spinal cord stimulation;Neuromodulation;Failed back surgery syndrome;Complex regional pain syndromes ;Pain ;Review

关键词

脊髓刺激;神经调节;背部手术失败综合征;复杂局部疼痛综合征;疼痛;综述

KEY POINTS

1.Randomized clinical trials for failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), and refractory angina pectoris (RAP) suggest that SCS has successful outcomes. 2.Psychological screening is paramount when determining who should be eligible for treatment with SCS. 

3.The patient’s response to a trial period of SCS is essential for predicting outcomes and identifying who should undergo permanent SCS implantation. 

4.Several decisions including the type of lead, anesthesia, and waveform programming need to be considered for each patient. 

5.SCS has been shown to have long-term cost-effectiveness for the treatment of chronic pain when compared with alternative treatment modalities.

关键点

1.随机临床实验表明SCS治疗背部手术失败综合征(FBSS)、复杂区域疼痛综合征(CRPS)和难治性心绞痛(RAP)有效。

2.心理筛查对决定谁有资格接受SCS治疗至关重要。

3.患者对试验期SCS反应对于预测治疗效果及确定谁应该接受永久性SCS植入是至关重要的

4。对于每个病人，都应考虑适合病人导线，麻醉和波形编程的类型

5.与其他治疗方式相比，SCS在治疗慢性疼痛方面具有长期的成本效益。

INTRODUCTION 

Spinal cord stimulation (SCS) of the dorsal columns was first used by Shealy and colleagues at Case Western Reserve University for the treatment of chronic intractable cancer pain in 1967. Premised around Melzack and Wall’s gate control theory of pain, it was initially hypothesized that electrical stimulation of Aβ fiber projections within the dorsal horn would inhibit nociceptive signals conducted by small A δ  and C fibers. This mechanism of action has been supported through observations that stimulating paresthesia coverage that overlaps with painful regions provides therapeutic relief. However, recent investigations have established nonconventional stimulation patterns that challenge this traditional paradigm and believed mechanism of action. Nonetheless, SCS has been well established as a safe and effective treatment of pain derived from a wide variety of etiologies. In this review, we discuss the common indications for SCS, patient selection criteria, and pertinent outcomes from randomized clinical trials (RCT) related to common indications treated with SCS.

前言

1967年，凯斯西储大学的Shealy及其同事首次使用脊髓刺激(SCS)来治疗慢性顽固性癌症疼痛。以Melzack和Wall的疼痛闸门控制学说为前提，起初假设电刺激背角内Aβ纤维投射，可以抑制小A δ 纤维和C纤维传导的伤害性信号。电刺激所致的感觉异常覆盖于疼痛区域，导致疼痛缓解的效果支持这一机制。然而，最近的研究已经建立了非传统的刺激模式，而这新模式也挑战了传统的范式和作用机制。尽管如此，SCS已经被确定为一种安全有效的治疗多种病因引起的疼痛的方法。在这篇综述中，我们讨论了SCS的常见适应证、患者选择标准以及与SCS治疗常见适应证相关的随机临床试验(RCT)的相关结果。