Navani Annu, Mahajan Gagan, Kreis Paul, Fishman Scott M
Bay Area Pain Center, Los Gatos, California, USA.
Pain Med. 2006 Sep-Oct;7(5):453-6. doi: 10.1111/j.1526-4637.2006.00217.x.
This report describes a case where pulsed radiofrequency lesioning (RFL) of the greater occipital nerve (GON) offered a valuable and safe treatment for the management of greater occipital neuralgia. The case is considered in relation to a review of the medical literature on greater occipital neuralgia and RFL interventions.
A 62-year-old man with a 43-year history of left suboccipital pain underwent pulsed RFL of the left GON (20-millisecond bursts at intervals of 0.5 second for 4 minutes at 42 degrees C) after failing to achieve substantial analgesia with naproxen, a transcutaneous electrical nerve stimulator (TENS) unit and a greater occipital nerve blockade (GONB) utilizing local anesthetic and steroid. After obtaining 4 months of 70% pain relief, pulsed RFL was repeated and resulted in an additional 5 months of 70% pain relief.
Pulsed RFL of the GON is an alternative to continuous RFL with the proposed advantage of mitigating pain, as in continuous RFL, but without the potential risk of causing deafferentation pain. While placebo and other nonspecific analgesic effects cannot be ruled out, the apparent safety profile and potential efficacy of pulsed RFL suggests it may be a compelling option to consider before irreversible neuroablative therapies are applied.
本报告描述了一例枕大神经（GON）脉冲射频消融术（RFL）为枕大神经痛的治疗提供了一种有价值且安全的治疗方法的病例。结合对枕大神经痛和RFL干预的医学文献回顾来考虑该病例。
一名有43年左枕下疼痛病史的62岁男性，在使用萘普生、经皮电刺激神经疗法（TENS）装置以及使用局部麻醉剂和类固醇进行枕大神经阻滞（GONB）均未能实现充分镇痛后，接受了左侧GON的脉冲RFL（在42摄氏度下，以0.5秒的间隔进行20毫秒的脉冲，持续4分钟）。在获得4个月70%的疼痛缓解后，重复进行脉冲RFL，又实现了5个月70%的疼痛缓解。
GON的脉冲RFL是连续RFL的一种替代方法，其优势在于与连续RFL一样能减轻疼痛，但没有导致去传入性疼痛的潜在风险。虽然不能排除安慰剂和其他非特异性镇痛作用，但脉冲RFL明显的安全性和潜在疗效表明，在应用不可逆神经消融疗法之前，它可能是一个值得考虑的有吸引力的选择。
