Therapy Habituation at 12 Months: Spinal Cord Stimulation Versus Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome Type I and II
| Autor: | Kasra Amirdelfan, James Scowcroft, Allen W. Burton, Nagy Mekhail, Adil Raza, Jason E. Pope, Timothy R. Deer, Robert M. Levy, Eric Grigsby, William Porter McRoberts, Leonardo Kapural, Michael Schaufele, Jeffrey Kramer, Alexander R. Kent, Sam Samuel, Abram H. Burgher, Peter S. Staats, Lawrence Poree, Stan Golovac, Richard Paicius |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Causalgia Time Factors Population Electric Stimulation Therapy Stimulation Tonic (physiology) law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Dorsal root ganglion 030202 anesthesiology law Ganglia Spinal Outcome Assessment Health Care Humans Medicine Habituation Habituation Psychophysiologic education Aged Spinal Cord Stimulation education.field_of_study business.industry Middle Aged medicine.disease Reflex Sympathetic Dystrophy Implantable Neurostimulators Anesthesiology and Pain Medicine medicine.anatomical_structure Complex regional pain syndrome nervous system Neurology Anesthesia Female Neurology (clinical) Implant business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | The Journal of Pain. 21:399-408 |
| ISSN: | 1526-5900 0192-3285 |
| Popis: | The ACCURATE randomized, controlled trial compared outcomes of dorsal root ganglion (DRG) stimulation versus tonic spinal cord stimulation (SCS) in 152 subjects with chronic lower extremity pain due to complex regional pain syndrome (CRPS) type I or II. This ACCURATE substudy was designed to evaluate whether therapy habituation occurs with DRG stimulation as compared to SCS through 12-months. A modified intention-to-treat analysis was performed to assess percentage pain relief (PPR) and responder rates at follow-up visits (end-of-trial, 1, 3, 6, 9, 12-months postpermanent implant) for all subjects that completed trial stimulation (DRG:N = 73, SCS:N = 72). For both groups, mean PPR was significantly greater at end-of-trial (DRG = 82.2%, SCS =0 77.0%) than all other follow-ups. Following permanent DRG system implantation, none of the time points were significantly different from one another in PPR (range = 69.3–73.9%). For the SCS group, PPR at 9-months (58.3%) and 12-months (57.9%) was significantly less than at 1-month (66.9%). The responder rate also decreased for the SCS group from 1-month (68.1%) to 12-months (61.1%). After stratifying by diagnosis, it was found that only the CRPS-I population had diminishing pain relief with SCS. DRG stimulation resulted in more stable pain relief through 12-months, while tonic SCS demonstrated therapy habituation at 9- and 12-months. Trial Registration: The ACCURATE study was registered at ClinicalTrials.gov with Identifier NCT01923285. Perspective This article reports on an ACCURATE substudy, which found that long-term therapy habituation occurred at 12-months with SCS, but not DRG stimulation, in patients with CRPS. The underlying mechanisms of action for these results remain unclear, although several lines of inquiry are proposed. |
| Databáze: | OpenAIRE |
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