Jung Yun Jae, Park Won Yong, Jeon Jong Hyun, Mun Jeong Hyeon, Cho Yoon Soo, Jun Ah Young, Jang Ki Un, Seo Cheong Hoon
Department of Rehabilitation Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
Department of Rehabilitation Medicine, Hangang Sacred-Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Ann Rehabil Med. 2014 Aug;38(4):523-33. doi: 10.5535/arm.2014.38.4.523. Epub 2014 Aug 28.
To investigate the effect of extracorporeal shock wave therapy (ESWT) on painful stump neuroma.
Thirty patients with stump neuroma at the distal end of an amputation site were assigned randomly to the ESWT group (n=15) and the transcutaneous electrical nerve stimulation (TENS)+desensitization+pharmacological treatment group (n=15). For 3 weeks, the ESWT group received a weekly session involving 1,500 pulses at 0.10 mJ/mm(2), while the control group was treated 10 times each, 40 minutes per day with TENS and desensitization treatment, and daily medication for 3 weeks. ESWT stimulation was given by focusing on the area at the neuroma site clearly identified by ultrasound.
The changes in the McGill pain questionnaire were 38.8±9.0 prior to treatment and 11.8±3.1 following the treatment. The corresponding values for the control group were 37.2±7.7 and 28.5±10.3. The changes between groups were significantly different (p=0.035). The change in visual analog scale prior to and after treatment was 7.0±1.5 and 2.8±0.8 in the ESWT group, respectively, and 7.2±1.4 and 5.8±2.0 in the control group. These changes between the groups were also significantly different (p=0.010). The outcome in the pain rating scale also showed significant differences between groups (p<0.001). Changes in neuroma size and pain pressure threshold (lb/cm(2)) were not significantly different between groups (p>0.05).
The study findings imply that ESWT for stump neuroma is superior to conventional therapy.
探讨体外冲击波疗法（ESWT）对残端神经瘤疼痛的影响。
将30例截肢部位远端残端神经瘤患者随机分为ESWT组（n = 15）和经皮电刺激神经疗法（TENS）+脱敏+药物治疗组（n = 15）。持续3周，ESWT组每周接受一次治疗，能量为0.10 mJ/mm(2)，共1500次脉冲，而对照组每天进行10次、每次40分钟的TENS和脱敏治疗，并持续3周每日用药。通过聚焦超声明确识别的神经瘤部位进行ESWT刺激。
麦吉尔疼痛问卷评分在治疗前为38.8±9.0，治疗后为11.8±3.1。对照组相应值分别为37.2±7.7和28.5±10.3。两组间变化有显著差异（p = 0.035）。ESWT组治疗前后视觉模拟量表评分变化分别为7.0±1.5和2.8±0.8，对照组为7.2±1.4和5.8±2.0。两组间这些变化也有显著差异（p = 0.010）。疼痛评定量表结果显示两组间也有显著差异（p<0.001）。神经瘤大小和疼痛压力阈值（lb/cm(2)）的变化在两组间无显著差异（p>0.05）。
研究结果表明，ESWT治疗残端神经瘤优于传统疗法。
