The Pain Management & Neuromodulation Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
Neuromodulation. 2011 May-Jun;14(3):253-7; discussion 257. doi: 10.1111/j.1525-1403.2011.00347.x. Epub 2011 Apr 8.
INTRODUCTION: The management of pain in chronic benign pancreatitis is complex. Celiac plexus neurolysis provides pain relief of variable duration. Neuromodulation of splanchnic nerves with electrodes and an implantable pulse generator system is an alternative to producing long-term pain relief with minimal complications in selected cases. METHODS: A 36-year-old lady with intractable abdominal pain for five years from chronic benign pancreatitis presented to our pain clinic. Multiple pharmacotherapy regimens, surgery, and interventions produced temporary pain relief of variable duration and intensity. Following a successful trial of celiac plexus stimulation, neuromodulation of the splanchnic nerves was achieved with two permanently implanted octopolar leads at the T11/T12 area connected to an implantable pulse generator. RESULTS: Eighteen months following the implant, the patient continues to derive satisfactory pain relief without any device related complications. Her opiate use is significantly reduced from 225 (486 mg morphine per day) to 12.5 (27 mg morphine per day) micrograms/h fentanyl patches and the fentanyl lozenges were stopped with an increase in appetite and of more than 8 kg in weight gain. The initial pain score visual analogue scale (VAS) 8-9/10 was reduced to VAS 0/10 since implantation. DISCUSSION: The pain of chronic pancreatitis has both visceral and somatic components as evidenced by the lack of complete pain relief from celiac plexus block alone and the knowledge that in chronic disease, the pathology extends to extra pancreatic somatic tissues, particularly the retro-peritoneum. We postulate that the electrical field generated by the dual octrode system extends to include splanchnic nerves and other somatic innervation of the pancreas. CONCLUSION: In our opinion, this is the first case of a successful long-term neuromodulation of splanchnic nerves with a permanently implanted device. The potential exists for its use in visceral abdominal pain of varied etiology, once more experience is obtained with this technique.
介绍：慢性良性胰腺炎的疼痛管理较为复杂。腹腔神经丛松解术可提供不同持续时间的止痛效果。对于特定病例，通过使用电极和可植入脉冲发生器系统对内脏神经进行神经调节，可在产生长期缓解疼痛的同时，将并发症的风险降到最低。
方法：一位 36 岁的女性，患有慢性良性胰腺炎，腹痛 5 年，来到我们的疼痛诊所。多种药物治疗方案、手术和介入治疗都只能暂时缓解不同程度和强度的疼痛。在腹腔神经丛刺激成功试验后，通过 T11/T12 区域的两根永久性植入的八极导联对内脏神经进行神经调节，这些导联与可植入脉冲发生器相连。
结果：在植入后的 18 个月，患者持续获得满意的疼痛缓解，没有任何与设备相关的并发症。她的阿片类药物用量从 225（每天 486 毫克吗啡）减少到 12.5（每天 27 毫克吗啡）微克/小时芬太尼贴片，并且停止使用芬太尼口含锭，同时食欲增加，体重增加超过 8 公斤。植入后，初始疼痛评分视觉模拟量表（VAS）从 8-9/10 降至 0/10。
讨论：慢性胰腺炎的疼痛既有内脏成分，也有躯体成分，这一点可以从腹腔神经丛阻滞单独治疗不能完全缓解疼痛以及在慢性疾病中，病理学延伸到胰腺外的躯体组织，特别是后腹膜得到证明。我们推测，双八极电极系统产生的电场延伸到包括内脏神经和胰腺的其他躯体神经支配。
结论：在我们看来，这是首例使用永久性植入设备成功进行长期内脏神经调节的病例。一旦我们获得了更多的这种技术经验，这种方法就有可能用于各种病因的内脏腹痛。
J Clin Gastroenterol. 2008-7
Reg Anesth Pain Med. 2010
Curr Gastroenterol Rep. 2006-4
Curr Treat Options Gastroenterol. 2016-9
Curr Pain Headache Rep. 2014-5
Wien Med Wochenschr. 2014-2
Zotero 插件