Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Rochester, MN.
Center for Pain Relief, Charleston, WV.
Mayo Clin Proc. 2016 Feb;91(2):246-58. doi: 10.1016/j.mayocp.2015.12.001.
Chronic pain represents one of the most important public health problems in terms of both the number of patients afflicted and health care costs. Most patients with chronic pain are treated with medications as the mainstay of therapy, and yet most medically treated patients continue to report ongoing pain. Additionally, adverse effects from pain medications represent a major challenge for clinicians and patients. Spinal cord stimulation and intrathecal drug delivery systems are well-established techniques that have been utilized for over 25 years. Intrathecal drug delivery systems have proven efficacy for a wide variety of intractable pain conditions and fewer adverse effects than systemic medical therapy in patients with refractory cancer-related pain. Spinal cord stimulation is cost-effective and provides improved pain control compared with medical therapy in patients with a variety of refractory pain conditions including complex regional pain syndrome, painful diabetic neuropathy, and chronic radiculopathy. Patients who have intractable pain that has not responded to reasonable attempts at conservative pain care measures should be referred to a qualified interventional pain specialist to determine candidacy for the procedures discussed in this article.
慢性疼痛是一个重要的公共健康问题，其涉及的患者数量和医疗保健费用都很高。大多数慢性疼痛患者接受药物治疗作为主要治疗方法，但大多数接受医学治疗的患者仍报告持续存在疼痛。此外，疼痛药物的不良反应对临床医生和患者来说是一个重大挑战。脊髓刺激和鞘内药物输送系统是经过充分验证的技术，已经使用了超过 25 年。鞘内药物输送系统已被证明对多种难治性疼痛病症有效，并且与难治性癌症相关疼痛患者的全身药物治疗相比，不良反应更少。与药物治疗相比，脊髓刺激在多种难治性疼痛病症（包括复杂性区域疼痛综合征、糖尿病性神经痛和慢性神经根病变）患者中具有成本效益，并能更好地控制疼痛。对于那些经合理尝试保守疼痛治疗措施仍无法缓解的难治性疼痛患者，应转介给合格的介入性疼痛专家，以确定是否适合进行本文讨论的这些程序。
