Christensen F L, Jensen T S
Afdeling TH, Rigshospitalet, København.
Ugeskr Laeger. 1991 Dec 2;153(49):3466-9.
In addition to the well known paraplegia or tetraplegia, lesions of the spinal cord frequently cause a series of disturbances of sensation in the segments around or distal to the lesion. Disturbances of sensation in spinal cord lesions are painful or non-painful. The painful and also the non-painful sensations may represent irritative and withdrawal phenomena. A series of central neurogenic pains seem to be best explained by spontaneous neuronal activity in sensory spinal cord neurones which have lost the peripheral, segmental and descending neuronal control from the nervous system. Surgical treatment of pain in cases of spinal cord lesions is rarely considered apart from root-avulsion where surgical lesion in the superficial part of the posterior horn is effective. No specific treatment is as yet available for pain and disturbances of sensation in cases of spinal cord injury. However, on the basis of our limited knowledge of the pathogenesis of these symptoms, future therapeutic strategy will be directed towards not only the peripheral but also the central points of attack. Treatment of painful conditions in patients with spinal cord injuries, as in other states of chronic pain, should also include social and psychological support.
除了众所周知的截瘫或四肢瘫外，脊髓损伤还经常在损伤部位周围或远端节段引起一系列感觉障碍。脊髓损伤中的感觉障碍有疼痛性或非疼痛性之分。疼痛性和非疼痛性感觉都可能代表刺激性和退缩现象。一系列中枢性神经源性疼痛似乎最好用脊髓感觉神经元的自发神经活动来解释，这些神经元已经失去了来自神经系统的外周、节段性和下行性神经控制。除了神经根撕脱（在后角浅表部分进行手术损伤有效）外，脊髓损伤病例的疼痛很少考虑手术治疗。目前尚无针对脊髓损伤所致疼痛和感觉障碍的特效治疗方法。然而，基于我们对这些症状发病机制的有限了解，未来的治疗策略不仅将针对外周，还将针对中枢攻击点。与其他慢性疼痛状态一样，脊髓损伤患者疼痛状况的治疗也应包括社会和心理支持。
