Whyte Ferguson Lucy
El Prado/Taos, NM, USA; University of New Mexico School of Medicine, Pain Center, Albuquerque, NM, USA; Project ECHO Chronic Pain and Headache Management, Albuquerque, NM, USA.
J Bodyw Mov Ther. 2014 Oct;18(4):501-13. doi: 10.1016/j.jbmt.2014.05.001. Epub 2014 May 14.
The treatment of severe chronic pain in young people following surgery for the correction of curvatures of idiopathic scoliosis (IS) is presented through two case histories. Effective treatment involved release of myofascial trigger points (TrPs) known to refer pain into the spine, and treatment of related fascia and joint dysfunction. The TrPs found to be contributing to spinal area pain were located in muscles at some distance from the spine rather than in the paraspinal muscles. Referred pain from these TrPs apparently accounted for pain throughout the base of the neck and thoracolumbar spine. Exploratory surgery was considered for one patient to address pain following rod placement but the second surgery became unnecessary when the pain was controlled with treatment of the myofascial pain and joint dysfunction. The other individual had both scoliosis and hyperkyphosis, had undergone primary scoliosis surgery, and subsequently underwent a second surgery to remove hardware in an attempt to address her persistent pain following the initial surgery (and because of dislodged screws). The second surgery did not, however, reduce her pain. In both cases these individuals, with severe chronic pain following scoliosis corrective surgery, experienced a marked decrease of pain after myofascial treatment. As will be discussed below, despite the fact that a significant minority of individuals who have scoliosis corrective surgery are thought to require a second surgery, and despite the fact that pain is the most common reason leading to such revision surgery, myofascial pain syndrome (MPS) had apparently not previously been considered as a possible factor in their pain.
通过两个病例介绍了青少年特发性脊柱侧弯（IS）矫正手术后严重慢性疼痛的治疗情况。有效的治疗包括松解已知会将疼痛牵涉至脊柱的肌筋膜触发点（TrP），以及治疗相关的筋膜和关节功能障碍。发现导致脊柱区域疼痛的触发点位于离脊柱有一定距离的肌肉中，而非椎旁肌。这些触发点的牵涉痛显然是颈部和胸腰椎底部疼痛的原因。其中一名患者考虑进行探查手术以解决置入棒材后的疼痛问题，但当通过治疗肌筋膜疼痛和关节功能障碍控制住疼痛后，第二次手术就不再必要。另一名患者既有脊柱侧弯又有脊柱后凸，接受了原发性脊柱侧弯手术，随后又进行了第二次手术取出内固定装置，试图解决初次手术后持续存在的疼痛问题（以及因为螺钉移位）。然而，第二次手术并没有减轻她的疼痛。在这两个病例中，这些脊柱侧弯矫正手术后患有严重慢性疼痛的患者，在接受肌筋膜治疗后疼痛明显减轻。如下文所述，尽管据认为有相当少数接受脊柱侧弯矫正手术的患者需要进行第二次手术，尽管疼痛是导致此类翻修手术的最常见原因，但肌筋膜疼痛综合征（MPS）此前显然未被视为其疼痛的可能因素。
