序贯法药物治疗脊髓损伤后中枢性疼痛

目的：研究应用序贯法药物治疗脊髓损伤后中枢性疼痛及临床效果。方法：自1994年至2008年共收治脊髓损伤后中枢性疼痛28例，其中男23例，女5例；年龄25—59岁，平均42岁。应用三级序贯法药物治疗，根据患者对药物治疗的反应，逐步调整药物治疗级别，直至疼痛缓解。根据治疗前后的VAS评分情况，评估药物镇痛效果。第一级：应用COX-2抑制剂。第二级：应用三环类抗抑郁药物阿米替林＋COX-2抑制剂＋卡马西平。第三级：应用阿米替林三环类抗抑郁药物＋加巴喷丁＋神经妥乐平或COX-2抑制剂。结果：28例均有不同程度的疼痛缓解。第一级药物治疗VAS评分降低（23．3±1．2）分，第二级药物治疗VAS评分降低（54．5±3．8）分，第三级药物治疗VAS评分降低（65．8±5．1）分。结论：应用三级序贯法药物治疗脊髓损伤后中枢性疼痛，具有疗效优良、不良反应少的优点。

Sequential drugs treatment for central pain following spinal cord injury

Objective: To investigate methods and therapeutic effects of sequential drugs treatment for central pain following spinal cord injury. Methods: A total of 28 patients suffered from central pain following spinal cord injury were treated with sequential drugs from 1994 to 2008,including 23 males and 5 females, ranging in age from 25 to 59 years(mean 42 years). According to the patients' response to drugs,the therapy grade was adjusted step by step until the pain was relieved. Basing on VAS scores before and after drugs treatment,analgesic effect was evaluated. The first grade drugs: COX-2 inhibitors. The second grade drugs:Tricyclic antidepressant drugs(Amitriptyline)+COX-2 inhibitors +Carbamazepine. The third grade drugs:Tricyclic antidepressant drugs(Amitriptyline)+ Gabapentin + Neurotropin / COX-2 inhibitors. Results: The pain of all of 28 patients was relieved to different extent. The VAS scores decreased by 23.3±1.2 in the first grade drugs treatment group. The VAS scores decreased by 54.5±3.8 in the second grade drugs treatment group. The VAS scores decreased by 65.8±5.1 in the third grade drugs treatment group(P<0.05). Conclusion: The sequential drugs treatment for central pain following spinal cord injury has a good analgesia effect and little adverse reaction.