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首页> 美国卫生研究院文献>British Journal of Pain >‘Pseudofailure’ of spinal cord stimulation for neuropathic pain following a new severe noxious stimulus: learning points from a case series of failed spinal cord stimulation for complex regional pain syndrome and failed back surgery syndrome
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‘Pseudofailure’ of spinal cord stimulation for neuropathic pain following a new severe noxious stimulus: learning points from a case series of failed spinal cord stimulation for complex regional pain syndrome and failed back surgery syndrome

机译：在新的严重伤害性刺激之后脊髓刺激 Pseudofailure用于神经性疼痛：从复杂区域性疼痛综合征和失败的背部手术综合征失败的一系列脊髓刺激案例中学习点

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Failure of spinal cord stimulation (SCS) may be due to hardware problems, migration of electrodes and, in the long-term, plasticity in the spinal cord with habituation to the stimulation current. We describe a series of seven patients who experienced acute therapeutic loss of SCS effects following an acute nociceptive event unrelated to primary pathology. There were no hardware problems. We called this ‘Pseudofailure’, as the effective stimulation returned in all patients following a period off stimulation or reprogramming. This phenomenon has not been reported previously in the literature. Over a 4-year period, we managed seven patients with this feature: four had received SCS for complex regional pain syndrome and three for failed back surgery syndrome. In all seven cases, there was cessation of the pain relief afforded by SCS following an acute painful event: four patients had trauma, two patients had domestic electric shock and one patient suffered shingles (varicella zoster infection). We excluded hardware-related problems in all cases. In two patients, SCS effects could be regained by an initial attempt at reprogramming. In the remaining five cases reprogramming was unsuccessful, and stimulation was switched off for several months before recommencing, when we discovered a return of good therapeutic effect. We conclude that SCS may seem to fail following a separate strong nociceptive stimulus. Stimulation may be regained with reprogramming or following a period with stimulation switched off. We would, therefore, advise against removal of SCS hardware in the first instance.
机译：脊髓刺激（SCS）的失败可能是由于硬件问题，电极迁移以及长期适应于刺激电流的脊髓可塑性引起的。我们描述了一系列的七名患者，这些患者在与主要病理学无关的急性伤害性事件发生后，经历了SCS急性治疗性丧失。没有硬件问题。我们称此为“假性失败”，是指经过一段时间的刺激或重新编程后，所有患者均恢复了有效刺激。这种现象以前在文献中没有报道过。在4年的时间里，我们治疗了7例具有此特征的患者：4例因复杂的区域性疼痛综合征而接受了SCS，另外3例因背部手术综合征而失败。在所有七例中，SCS均在急性疼痛事件后停止了止痛措施：四名患者受伤，两名患者发生家庭电击，一名患者带状疱疹（水痘带状疱疹感染）。在所有情况下，我们都排除了与硬件相关的问题。在两名患者中，可以通过重新编程的初步尝试来恢复SCS的效果。在剩下的五种情况下，重新编程均未成功，并且当我们发现恢复了良好的治疗效果后，在重新开始刺激之前将其关闭了几个月。我们得出的结论是，在单独的强烈伤害性刺激刺激下，SCS似乎失败了。可以通过重新编程或在关闭刺激的一段时间后重新获得刺激。因此，我们建议您不要在一开始就删除SCS硬件。

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