Kapural Leonardo, Stillman Mark, Kapural Miranda, McIntyre Patrick, Guirgius Maged, Mekhail Nagy
Pain Management Department, Division of Anesthesiology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Pain Pract. 2007 Dec;7(4):337-40. doi: 10.1111/j.1533-2500.2007.00150.x. Epub 2007 Nov 6.
Persistent occipital neuralgia can produce severe headaches that are difficult to control by conservative or surgical approaches. We retrospectively describe a series of six patients with severe occipital neuralgia who received conservative and interventional therapies, including oral antidepressants, membrane stabilizers, opioids, and traditional occipital nerve blocks without significant relief. This group then underwent occipital nerve blocks using the botulinum toxin type A (BoNT-A) BOTOX Type A (Allergan, Inc., Irvine, CA, U.S.A.) 50 U for each block (100 U if bilateral). Significant decreases in pain Visual Analog Scale (VAS) scores and improvement in Pain Disability Index (PDI) were observed at four weeks follow-up in five out of six patients following BoNT-A occipital nerve block. The mean VAS score changed from 8 +/- 1.8 (median score of 8.5) to 2 +/- 2.7 (median score of 1), while PDI improved from 51.5 +/- 17.6 (median 56) to 19.5 +/- 21 (median 17.5) and the duration of the pain relief increased to an average of 16.3 +/- 3.2 weeks (median 16) from an average of 1.9 +/- 0.5 weeks (median 2) compared to diagnostic 0.5% bupivacaine block. Following block resolution, the average pain scores and PDI returned to similar levels as before BoNT-A block. In conclusion, BoNT-A occipital nerve blocks provided a much longer duration of analgesia than diagnostic local anesthetics. The functional capacity improvement measured by PDI was profound enough in the majority of the patients to allow patients to resume their regular daily activities for a period of time.
持续性枕神经痛可导致严重头痛，采用保守治疗或手术方法均难以控制。我们回顾性描述了6例严重枕神经痛患者，他们接受了保守治疗和介入治疗，包括口服抗抑郁药、膜稳定剂、阿片类药物以及传统枕神经阻滞，但均未获得显著缓解。随后，该组患者接受了A型肉毒毒素（BoNT-A）枕神经阻滞，使用美国加利福尼亚州欧文市艾尔建公司生产的保妥适A型（BOTOX Type A），每次阻滞剂量为50单位（双侧阻滞则为100单位）。在接受BoNT-A枕神经阻滞后的6例患者中，有5例在4周随访时疼痛视觉模拟评分（VAS）显著降低，疼痛残疾指数（PDI）得到改善。VAS评分均值从8±1.8（中位数为8.5）降至2±2.7（中位数为1），而PDI从51.5±17.6（中位数为56）改善至19.5±21（中位数为17.5），与诊断性0.5%布比卡因阻滞相比，疼痛缓解持续时间从平均1.9±0.5周（中位数为2周）延长至平均16.3±3.2周（中位数为16周）。阻滞效果消退后，平均疼痛评分和PDI恢复至BoNT-A阻滞前的类似水平。总之，BoNT-A枕神经阻滞提供的镇痛持续时间比诊断性局部麻醉药长得多。通过PDI测量的功能能力改善在大多数患者中足够显著，使患者能够在一段时间内恢复正常日常活动。
