Ege Üniversitesi Tıp Fakültesi Algoloji Kliniği'nde spinal kord stimülatörü takılan hastaların retrospektif değerlendirilmesi
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Dosyalar
Tarih
2019
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Ağrı, Uluslararası Ağrı Araştırma Grubu (IASP=International Association of the Study of Pain) tarafından "gerçek veya olası doku hasarına bağlı ortaya çıkan, insanın geçmişteki deneyimleri ile ilgili, hoş olmayan duyusal ve duygusal deneyim" olarak tanımlanmaktadır. Kronik ağrı ise; yaşam kalitesini bozan, ciddi iş gücü kaybı ve ekonomik kayıplara neden olan bir toplumsal sorundur. Kronik ağrı tedavisinde, konvansiyonel tedavi yöntemlerinin yetersiz kaldığı veya başarısız olduğu durumlarda girişimsel tedavi yöntemleri kullanılmaktadır. Girişimsel yöntemler içinde nöromodülasyon teknikleri önemli bir yer tutmaktadır. Nöromodülasyon uygulamaları, ağrı yolaklarının dinamik veya fonksiyonel inhibisyonu temeline dayanır. Spinal Kord Stimülatörü (SKS), nöromodülasyon teknikleri arasında en sık uygulanan tedavi yöntemidir. Çalışmamızda, Ege Üniversitesi Tıp Fakültesi Algoloji Bilim Dalı'nda Ocak 2007- Mayıs 2018 tarihleri arasında Spinal Kord Stimülatörü takılmış 33 hastanın dosyaları retrospektif olarak tarandı. Hastaların demografik özellikleri, primer ağrı nedeni, ağrının lokalizasyonu, süresi, şiddeti ve niteliği, işlem öncesi ve işlem sonrası opioid tüketimi, işlem öncesi ve sonrasında uygulanmış olan ağrı skalaları, bu yönteme ilişkin erken veya geç dönemde oluşan komplikasyonlar ve yan etkiler kaydedildi. Kullanılan farklı opioidler arasındaki dozaj ve formülasyon farklılıkları açısından ortak bir kanıya varabilmek için, hastaların kullandığı tüm opioidler, oral morfin eş değer dozuna çevrilip hesaplandı. Hastalara işlem öncesi ve sonrası yapılmış olan Sayısal Derecelendirme Skalası (NRS), Oswestry Engellilik Ölçütü (ODI) ve hasta memnuniyet anketi, dosyaları incelenerek kaydedildi. Çalışmadaki hastaların NRS skorlarındaki düşüş istatistiksel olarak anlamlı bulundu (p<0,001). Ağrı bölgesi alt ekstremite ve ayak olan olguların, ODI skorlarındaki düşüş istatistiksel olarak anlamlı bulundu (p<0,001). Çalışmaya dâhil edilen tüm hastalar, SKS implante edilmeden önce opioid kullanmakta iken, SKS implantasyonu sonrası hastaların en az yarısı opioid kullanımını bırakmıştır. SKS uygulandıktan sonra opioid kullanımına devam eden 14 hastanın, 9'u ise ilacın kullanım dozunu azaltmıştır. Opioid kullanımındaki düşüş istatistiksel olarak anlamlı bulunmuştur (p<0,001). Yaptığımız çalışmanın ve literatürde SKS hakkında yapılan diğer çalışmaların sonuçları doğrultusunda; SKS'nin kronik ağrı palyasyonunda oldukça etkili, güvenilir ve konvansiyonel tedavi yöntemleri ile karşılastırıldığında uzun dönemde, daha düşük maliyetli bir tedavi yöntemi olduğunu düşünmekteyiz.
Pain is defined by the International Association of the Pain Research Group (IASP) as “an unpleasant sensory and emotional experience, related to past human experience, which results from actual or possible tissue damage”. Chronic pain, on the other hand, is a social problem that deteriorates the quality of life and causes serious labor loss and economic losses. In the treatment of chronic pain, interventional treatment methods are used when conventional treatment methods fail or remain incapable. Neuromodulation techniques have an important place in the interventional methods. Neuromodulation applications are based on dynamic or functional inhibition of pain pathways. Spinal Cord Stimulator (SCS) is the most common treatment modality among neuromodulation techniques. In this study, the records of 33 patients who were implanted with Spinal Cord Stimulator between January 2007 and May 2018 in the Department of Algology of Ege University Faculty of Medicine were retrospectively reviewed. Patients' demographic characteristics, primary cause of pain, localization, duration, severity and quality of pain, pre- and post-opioid consumption, pain scales applied before and after the procedure, early and late complications and side effects were recorded. In order to reach a common understanding of the differences in dosage and formulation between the different opioids usage, all opioids used by the patients were converted to the equivalent dose of oral morphine and calculated. Patients’ files are examined, and Numerical Rating Scale (NRS), which is a before and after procedure that performed to patients, Oswestry Disability Index (ODI) and patient satisfaction questionnaire were recorded. The decrease in patients’ NRS scores was found statistically significant (p<0,001). In the cases, whose pain areas were lower extremity and foot, the decrease in NRS scores was found statistically significant (p<0,001). While all patients included in the study were using opioid before implantation of SCS, at least half of them stopped using opioid after SKS implantation. Of the 14 patients who continued opioid use after SKS implantation, 9 of them decreased the dosage of the medication. The decrease in opioid usage was found statistically significant (p<0,001). In line with the results of our study and other studies about SCS in the literature; we think that SCS is a more effective, reliable and low-cost treatment in chronic pain palliation compared to conventional treatment methods in the long term.
Pain is defined by the International Association of the Pain Research Group (IASP) as “an unpleasant sensory and emotional experience, related to past human experience, which results from actual or possible tissue damage”. Chronic pain, on the other hand, is a social problem that deteriorates the quality of life and causes serious labor loss and economic losses. In the treatment of chronic pain, interventional treatment methods are used when conventional treatment methods fail or remain incapable. Neuromodulation techniques have an important place in the interventional methods. Neuromodulation applications are based on dynamic or functional inhibition of pain pathways. Spinal Cord Stimulator (SCS) is the most common treatment modality among neuromodulation techniques. In this study, the records of 33 patients who were implanted with Spinal Cord Stimulator between January 2007 and May 2018 in the Department of Algology of Ege University Faculty of Medicine were retrospectively reviewed. Patients' demographic characteristics, primary cause of pain, localization, duration, severity and quality of pain, pre- and post-opioid consumption, pain scales applied before and after the procedure, early and late complications and side effects were recorded. In order to reach a common understanding of the differences in dosage and formulation between the different opioids usage, all opioids used by the patients were converted to the equivalent dose of oral morphine and calculated. Patients’ files are examined, and Numerical Rating Scale (NRS), which is a before and after procedure that performed to patients, Oswestry Disability Index (ODI) and patient satisfaction questionnaire were recorded. The decrease in patients’ NRS scores was found statistically significant (p<0,001). In the cases, whose pain areas were lower extremity and foot, the decrease in NRS scores was found statistically significant (p<0,001). While all patients included in the study were using opioid before implantation of SCS, at least half of them stopped using opioid after SKS implantation. Of the 14 patients who continued opioid use after SKS implantation, 9 of them decreased the dosage of the medication. The decrease in opioid usage was found statistically significant (p<0,001). In line with the results of our study and other studies about SCS in the literature; we think that SCS is a more effective, reliable and low-cost treatment in chronic pain palliation compared to conventional treatment methods in the long term.
Açıklama
Anahtar Kelimeler
Ağrı Yönetimi, Bel Ağrısı, Spinal Kord Stimülasyonu, Başarısız Bel Cerrahisi Sendromu, Pain Management, Low Back Pain, Spinal Cord Stimulation, Failed Back Surgery Syndrome
