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Клиническая эффективность обезболивания импульсной радиочастотной аблации нервных корешков у больных с метастатическим поражением позвоночника
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
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Kuznetsov SF, Babkin NS, Valiev AK, Kabardaev RM, Borzov KA. Pain relief clinical efficacy using pulsed radiofrequency ablation of nerve roots in patients with spine metastatic lesions. A prospective study. Journal of Modern Oncology. 2024;26(4):495–503. DOI: 10.26442/18151434.2024.4.203008
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Материалы и методы. В работе проводился анализ данных 230 пациентов с болевым синдромом, связанным с метастатическим поражением позвоночника, участники распределены на две группы. В 1-ю группу включены 156 пациентов, которым проведена ИРЧА нервных корешков в целях облегчения боли. Среди них – 69 мужчин и 87 женщин. Вторая группа, которая получала только фармакотерапию неопиоидными и опиоидными анальгетиками, включала 74 пациента, среди которых 30 мужчин и 44 женщины. Функциональный статус оценивали по шкале Карновского в %, интенсивность боли оценивали по нумерологической оценочной шкале от 0 до 10 (NRS), сокращение объема потребления анальгетиков оценивали по шкале Watkins scale. Общая удовлетворенность от лечения у пациентов и врачей оценивалась по шкале Лайкерта.
Результаты. В группе ИРЧА у 124 (79,5%) больных из 156 терапия оказалась эффективной в виде снижения NRS как минимум на 50% и снижения как минимум на 1 балл по Watkins scale. Функциональный статус улучшился как минимум на 10% по индексу Карновского у 121 (77,6%) больного. В контрольной группе эффективность фармакотерапии на основании NRS достигнута у 65 (87,8%) пациентов из 74, а общий соматический статус – у 60 (81,1%) пациентов. Максимальный обезболивающий эффект применения ИРЧА нервного корешка достигается на 10-е сутки после процедуры и остается стабильным до 90 сут. Уровень статистической значимости составил p<0,001. В группе ИРЧА у 153 (98,01%) больных не отмечалось осложнений, в контрольной группе осложнения отмечены в 64 (86,5%) случаях, проявлялись в виде неблагоприятных явлений от используемых для контроля боли анальгетиков. Исходно до начала исследования все 100% пациентов в обеих группах отмечали неудовлетворенность терапией боли до обращения к вертебрологу. Доля неудовлетворительных оценок по шкале Лайкерта при проведении лечения в группе ИРЧА уменьшилась до 20,5% (32 пациента), а в группе фармакотерапии – до 28,4% (21 пациент) соответственно.
Заключение. ИРЧА нервных корешков представляет собой высокоэффективный и безопасный малоинвазивный нейромодулирующий метод лечения боли у онкологических пациентов с компрессией нервных корешков, вызванной метастазами в позвоночнике. Этот метод позволяет в короткие сроки снизить или уменьшить выраженность болевого синдрома у 79,5% больных, что способствует повышению их физической активности и улучшает качество жизни, снижает неблагоприятные явления, обусловленные системным приемом анальгетиков, у 77,6% пациентов. ИРЧА нервных корешков имеет преимущества по сравнению с консервативным лечением в различных аспектах: снижение интенсивности болевого синдрома, повышение удовлетворенности пациентов результатами лечения, существенное уменьшение фармакологической нагрузки и связанных с ней осложнений, улучшение физической активности и качества жизни пациентов.
Ключевые слова: вертебральная онкология, онкологическая боль, фармакотерапия боли, костные метастазы, региональная анестезия, лучевая терапия, чрескожная вертебропластика, нейролизис, импульсная радиочастотная аблация, нейромодуляция
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Aim. The objective of the study is to evaluate the clinical efficacy and safety of PRFA (pulsed radiofrequency ablation) of nerve roots in improving general somatic and functional status (Karnofsky score), decreasing pain (NRS) and reducing analgesics consumption (Watkins score) in patients with spine metastatic lesions.
Materials and methods. This study involved the analysis of 230 patients with pain syndrome related to metastatic lesions in the spine. Those patients were divided into two groups. The first group included 156 patients who underwent Pulsed RFA of nerve roots in order to relieve pain. There were 69 men and 87 women. The second group, which received only drug treatment with non-opioid and opioid analgesics, consisted of 74 patients, including 30 men and 44 women. The performance status was evaluated with the Karnofsky score (%), pain degree was assessed with the Numerical Rating Scale from 0 to 10 (NRS), and analgesics consumption reduction was assessed by the Watkins scale. Overall treatment satisfaction in patients and physicians was evaluated with the Likert scale.
Results. In the pulsed RFA group, 124 (79.5%) patients out of 156 had effective therapy in the form of NRS decrease of at least 50% and at least 1 point decrease by the Watkins scale. The performance status improved by at least 10% according to the Karnofsky index in 121 (77.6%) patients. As for the control group, the effectiveness of pharmacotherapy based on NRS was achieved in 65 (87.8%) out of 74 patients, and the general somatic status was improved in 60 (81.1%) patients. The maximum analgesic effect of the nerve root RFA is achieved on the 10th day after the procedure, maintaining for up to 90 days without dynamics. The level of statistical significance was p<0.001. In the RFA group, 153 (98.01%) patients experienced no complications, and in the control group, complications were seen in 64 (86.5%) cases, manifested themselves in the form of adverse events from analgesics used for pain control. Originally, prior to the study, all 100% of patients in both groups expressed pain therapy dissatisfaction before consulting a vertebrologist. The unsatisfactory score proportion on the Likert scale during the treatment in the RFA group decreased to 20.5% (32), and in the pharmacotherapy group – to 28.4% (21), respectively.
Conclusion. Pulsed radiofrequency ablation of nerve roots is highly effective and safe, minimally invasive neuromodulatory method for pain treatment in cancer patients with nerve roots compression caused by the spine metastases. This method allows within a short period to reduce or decrease the severity of pain syndrome in 79.5% of patients, contributing to their physical activity increase and improving the quality of life in 77.6% of patients. Pulsed RFA of nerve roots has advantages over conservative treatment in various aspects: decrease in pain syndrome intensity, enhanced patients satisfaction with treatment results, significant pharmacological stress and its associated complications reduction, improved patients physi-cal activity and quality of life.
Keywords: vertebral oncology, cancer pain, pharmacotherapy of pain, bone metastases, regional anesthesia, radiation therapy, percutaneous vertebroplasty, neurolysis, pulsed radiofrequency ablation, neuromodulation
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ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России, Москва, Россия
*kuzstas@gmail.com
________________________________________________
Stanislav F. Kuznetsov*, Nikita S. Babkin, Aslan K. Valiev, Ruslan M. Kabardaev, Kirill A. Borzov
Blokhin National Medical Research Center of Oncology, Moscow, Russia
*kuzstas@gmail.com