短时程兼频脊髓电刺激治疗带状疱疹后神经痛的临床研究

Short-Term Differential Target Multiplexed Spinal Cord Stimulation for Postherpetic Neuralgia

摘要:

目的：探究短时程脊髓电刺激(short-term spinal cord stimulation, st-SCS)在兼频(differential target multiplexed, DTM )刺激模式下治疗带状疱疹后神经痛(postherpetic neuralgia, PHN)的临床疗效。方法：选取2023年9月1日至2025年8月31日就诊于青岛市市立医院疼痛科,确诊为带状疱疹后神经痛的患者共60例,使用随机数字法分为兼频治疗组和标准对照组,每组30例。两组患者入院后同时给予普瑞巴林进行基础治疗,对两组患者都经手术植入电极,进行短时程脊髓电刺激治疗共10天。兼频治疗组的程控模式设置为兼频刺激模式,标准对照组的程控模式设置为传统刺激模式。对两组患者在入组后以及治疗后3天、7天、10天、1个月评估疼痛程度、睡眠质量、生活质量以及负性情绪的变化。使用视觉模拟评分法(visual analogue scale, VAS)评估患者疼痛程度,使用匹兹堡睡眠质量指数(Pittsburg sleep quality index, PSQI)评估患者睡眠质量,使用SF-12生活质量评分量表(Short Form-12 Health Survey, SF-12)评估患者生活质量,使用焦虑自评量表(self-rating anxiety scale, SAS)评估患者负性情绪。结果：兼频治疗组脱落1例,最终共计59例患者纳入研究。两组患者的疼痛程度、睡眠质量、生活质量以及负性情绪均有改善(P＜0.05)。兼频治疗组较标准对照组更早出现改善效果,在治疗后3天、7天、10天时的改善更为明显,两组比较差异有统计学意义(P＜0.05)。在治疗后1个月时的治疗效果差异无统计学意义(P＜0.05)。结论：短时程脊髓电刺激在兼频刺激模式下可有效治疗带状疱疹后神经痛。与标准刺激模式下的短时程脊髓电刺激相比,尽管在长期来看,两种模式在PHN的效果相仿,但是在疼痛程度、睡眠质量、生活质量以及负性情绪的变化方面,兼频刺激模式的短时程电刺激治疗改善更快,疗效更稳定。

Abstract:

Objective: To investigate the clinical efficacy of short-term spinal cord stimulation (st-SCS) using the differential target multiplexed (DTM) programming mode in the treatment of postherpetic neuralgia (PHN). Methods: A total of 60 patients diagnosed with PHN at the Pain Department of Qingdao Municipal Hospital between September 1, 2023, and August 31, 2025, were enrolled and randomly divided into two groups using a random number method: the DTM group and the standard control group, with 30 patients in each group. Both groups received baseline treatment with pregabalin after admission and underwent surgical electrode implantation for short-term spinal cord stimulation over a period of 10 days. The DTM group was programmed with the DTM stimulation mode, while the standard control group received traditional stimulation. Pain intensity, sleep quality, quality of life, and negative emotions were assessed at baseline and at 3 days, 7 days, 10 days, and 1 month after treatment. Pain intensity was evaluated using the Visual Analogue Scale (VAS), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), quality of life was measured with the Short Form-12 Health Survey (SF-12), and negative emotions were evaluated using the Self-Rating Anxiety Scale (SAS). Results: One patient from the DTM group dropped out, leaving 59 patients included in the final analysis. Both groups showed significant improvements in all outcome measures (P < 0.05). The DTM group, however, exhibited a more rapid response, with superior outcomes observed at 3 days 7 days and 10 days after treatment, showing statistically significant differences compared to the standard control group (P < 0.05). No statistically significant differences were observed between the two groups at 1 month after treatment. Conclusion: Short-term spinal cord stimulation using the DTM programming mode is effective in treating postherpetic neuralgia. While the long-term effects of both stimulation modes are comparable, the DTM mode provides a distinct advantage by offering faster symptomatic relief in terms of pain intensity, sleep quality, quality of life, and negative emotions.