神经增强技术治疗慢性疼痛

背景:神经增强在这里特指通过电刺激某些神经结构的方法,调整痛觉治疗临床疼痛的技术,其理论基础是闸门控制学说。目前神经增强技术治疗慢性顽固性疼痛已经得到越来越广泛的应用。目的:收集公开发表的有关神经增强技术治疗慢性顽固性疼痛的文献并评估它的有效性。资料来源:计算机检索了Medline1966/2003-07所有与神经增强技术治疗慢性疼痛相关文献,并对引文做了进一步查找。检索词:euroaug-mentation,chronicpain,neurostimulation,并限定文章语言种类为英语。资料选择:对资料进行初审,选取符合如下条件的临床研究:①研究对象为其他治疗无效的慢性顽固性疼痛患者。②样本数大于15例。③随访时间大于1年。排除Meta分析。资料提炼:从检索到的所有文献中选取近5年的以患者为研究对象的14篇作为参考文献,对所引用的文献可靠性进行评估,选取大样本的结果作为本文引用数据。资料综合:超过10000例慢性顽固性疼痛的患者接受了神经增强技术治疗,应用最广泛的是脊髓刺激。至今无随机临床试验研究(RCT)。在所有的临床研究中接受治疗的患者长期有效率大于50%。结论:接受神经增强技术治疗慢性疼痛的患者不断增加。它为那些其他治疗无效的或因疼痛而致残的患者带来确实的希望。     

慢性疼痛的运动疗法

文章介绍了运动疗法治疗慢性疼痛的适应证和禁忌证、运动处方等内容,其中运动处方中又包括了处方目的、运动形式、运动频率、运动强度和运动持续时间,简要介绍了引起慢性疼痛常见疾病如颈椎病、肩周炎、偏瘫肩痛、反复发作的腰椎间盘突出症等的具体的运动疗法。     

Gene therapy for chronic pain

The dorsal horn of the spinal cord represents an attractive site for interventions designed to treat chronic pain, but it has been difficult to identify small molecules that act selectively on pain transmission at the spinal level. One approach is the use of viral vector-mediated gene transfer to achieve focal production and release of short-lived analgesic peptides. Herpes simplex virusbased vectors, expressing proenkephalin delivered by subcutaneous inoculation, transduce neurons of the dorsal root ganglion, leading to release of enkephalin from nerve terminals in dorsal horn to produce an analgesic effect in several models of chronic pain. A clinical trial is set to commence.     

Hyperbaric oxygen therapy in chronic pain management

Chronic pain is one of the frequently encountered clinical problems that is difficult to cure. Hyperbaric oxygen (HBO) therapy has been reported in chronic pain syndromes with promising results. In this review, we focus on the effectiveness of HBO in fibromyalgia syndrome, complex regional pain syndrome, myofascial pain syndrome, migraine, and cluster headaches. HBO may be beneficial if appropriate patients are selected. HBO is a reliable method of treatment. However, physicians performing HBO must be aware of oxygen toxicity. Another problem regarding HBO is the scarcity of centers administering it. Further research is required focusing on the optimal treatment protocol, the cost/benefit ratio, and the safety of HBO in chronic pain management.     

Spinal cord stimulation in chronic pain therapy

Spinal cord stimulation was undertaken in 45 patients referred to the University Hospital in Ghent. Failed back surgery was the major indication for implantation. Raynaud's phenomenon, causalgia, polyneuropathy, phantom limb pain, and diverse causes were the other indications. Before neurosurgical implantation of the system, a percutaneous epidural trial procedure was performed. The efficacy of the implanted stimulation system was estimated by considering the use of medication and the patients' personal appreciation of the obtained pain relief. Thirty-five patients experienced very good pain relief. Only two patients needed further narcotic analgesics. Eight patients stopped using the stimulation system. To ensure good results, strict selection criteria and many surgical reinterventions seemed to be necessary. Although spinal cord stimulation is a nonablative technique, many complications may occur.     

Long-term oral opioid therapy in patients with chronic nonmalignant pain.

In contrast to the use of opioids for the treatment of acute and chronic cancer pain, the administration of chronic opioid therapy for pain not due to malignancy remains controversial. We describe 100 patients who were chronically given opioids for treatment of nonmalignant pain. Most patients experienced neuropathic pain or back pain. We used sustained-release dihydrocodeine, buprenorphine, and sustained-release morphine. Pain reduction was measured with visual analogue scales (VAS), and the Karnofsky Performance Status Scale was used to assess the patient's function. Good pain relief was obtained in 51 patients and partial pain relief was reported by 28 patients. Only 21 patients had no beneficial effect from opioid therapy. There was a close correlation between the sum and the peak VAS values (r = 0.983; p less than 0.0001) and pain reduction was associated with an increase in performance (p less than 0.0001). The most common side effects were constipation and nausea. There were no cases of respiratory depression or addiction to opioids. Our results indicate that opioids can be effective in chronic nonmalignant pain, with side effects that are comparable to those that complicate the treatment of cancer pain.     

局部注射类固醇治疗颈肩腰腿痛1060例

背景颈肩腰腿痛是一类较难治愈的疾病,治疗的方法多种多样,复发率高.目的了解局部注射类固醇颈肩腰腿痛的疗效,旨在找出一种简单快速方法治愈这类疾病.设计以诊断为依据自身对照研究.地点和对象实验在同济医院外科门诊颈肩腰腿痛诊疗中心完成,对象为1251例颈肩腰腿痛患者,男504例,女747例;年龄19～84岁,平均49.1岁.干预在控制用药剂量和时间的前提下,采用局部注射类固醇,并且以栽小针刀、针灸为辅助治疗的方法治疗颈肩腰腿痛,并分别于治疗后1～6次逐次进行疗效评定.主要观察指标患者的症状及自身感觉.结果1251例患者中经治疗有完整资料的1060例,基本痊愈为95.3%,无好转为4.7%.结论用类固醇局部注射治疗颈肩腰腿痛是一项有效的治疗方法.     

Physical therapy in the management of women with chronic pelvic pain

OBJECTIVES: Chronic pelvic pain (CPP) is defined as lower abdominal pain lasting for at least 6 months, which occurs continuously or intermittently and is not associated exclusively with menstruation or intercourse. CPP is a highly prevalent debilitating disease with negative impact on the quality of life and productivity of women. The dilemma regarding the management of CPP continues to frustrate the health professionals, partly because its physiopathology is poorly understood. Consequently, the treatment of this condition is often unsatisfactory and limited to temporary symptom relief. In the present review, we discuss characteristics of the clinical history and physical examination associated with musculoskeletal involvement in women with CPP and possible treatments, especially in the area of physiotherapy. METHODS: We evaluated data available in PubMed (1984-2006) and surveyed the reference list. Three reviewers analysed the data independently, considering a study to be of high quality if it had at least three of the following characteristics: prospective design, valid measurement instruments, and adequate sample estimate and response rate. Other studies such as retrospective investigations, reviews and expert opinions were also considered, but with decreasing emphasis. RESULTS: There are evidences of musculoskeletal system disorders in most women with CPP. These musculoskeletal disorders can be the primary cause of CPP or postural changes and pelvic muscle contractures secondary to CPP. CONCLUSIONS: Synchronised intervention by physicians and physiotherapists is becoming increasingly more necessary both in terms of a more refined diagnosis of the clinical situation and of the institution of effective and lasting treatment.