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Journal of pain research
Par Lin P, Li L, Weng LH et 7 autres.
Contenu en anglais
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While short-term spinal cord stimulation (stSCS) and bipolar pulsed radiofrequency (bPRF) are used for zoster-associated pain (ZAP), their comparative outcomes and baseline cognition's prognostic value remain underexplored. We compared 12-month pain response and secondary pain, sleep, and cognitive outcomes at multiple follow-up visits, and explored baseline response predictors.
After excluding 63 craniofacial cases from 284 retrospectively evaluated patients, 1:1 propensity score matching yielded 100 patients (50 pairs). The primary outcome was a ≥50% reduction in Numeric Rating Scale (NRS) score at 12 months. Secondary NRS, Pittsburgh Sleep Quality Index (PSQI), and Montreal Cognitive Assessment (MoCA) scores were analyzed using adjusted linear mixed-effects models. Ridge models with and without baseline MoCA were internally validated using 1000 matched-pair bootstrap resamples.
Response rates were 66.0% with stSCS and 52.0% with bPRF (risk difference, 14.0 percentage points; 95% CI, -6.0 to 34.0; P = 0.178). stSCS was associated with lower NRS scores at 1 week and higher MoCA scores at 3, 6, and 12 months (12-month adjusted difference, 1.24; 95% CI, 0.69-1.80). PSQI differences were not significant. Higher baseline MoCA (penalized odds ratio, 2.113; bootstrap 95% CI, 1.146-3.427), higher baseline NRS, and older age were associated with response. The optimism-corrected area under the receiver operating characteristic curve was 0.802 versus 0.717 without MoCA.
stSCS was associated with higher follow-up MoCA scores, although 12-month response rates did not differ significantly. Baseline cognition showed prognostic potential, supporting further evaluation of cognitive assessment in ZAP. The nomogram showed promising internal performance; prospective studies incorporating standardized assessment and medication monitoring are needed to confirm these findings and externally validate the model.
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