Deng Zhengdao, Pan Yixin, Li Dianyou, Zhang Chencheng, Jin Haiyan, Wang Tao, Zhan Shikun, Sun Bomin
Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
World Neurosurg. 2019 Jan;121:196-200. doi: 10.1016/j.wneu.2018.10.008. Epub 2018 Oct 10.
The presence of neuropathic pain can severely impinge on emotional regulation and activities of daily living including social activities, resulting in diminished life satisfaction. Unfortunately, the majority of patients with neuropathic pain do not experience an amelioration of symptoms from conventional therapies, even when multimodal therapies are used. Chronic refractory neuropathic pain is usually accompanied by severe depression that is prone to incur suicidal events; thus clinical management of chronic neuropathic pain and depression presents a serious challenge for clinicians and patients.
Two patients presented at our institution with neuropathic pain and severe depression. The patients had different pain symptoms emerging a few months after central or peripheral nervous system impairment. These symptoms were associated with the development of severe depression, social isolation, and a gradual inability to perform daily activities. Both patients were referred to our treatment center for bilateral anterior cingulotomy. After surgery, both patients showed significant progressive improvements in perceived pain, mental health status, and daily functioning.
Bilateral anterior cingulotomy may serve as an alternative treatment for medically refractory neuropathic pain, especially for patients who also experience depression.
神经性疼痛的存在会严重影响情绪调节以及包括社交活动在内的日常生活活动，导致生活满意度下降。不幸的是，大多数神经性疼痛患者即使采用多模式疗法，也无法从传统疗法中获得症状改善。慢性难治性神经性疼痛通常伴有严重抑郁症，容易引发自杀事件；因此，慢性神经性疼痛和抑郁症的临床管理对临床医生和患者来说都是一项严峻挑战。
两名患者因神经性疼痛和严重抑郁症前来我院就诊。患者在中枢或周围神经系统受损数月后出现不同的疼痛症状。这些症状与严重抑郁症、社交隔离以及逐渐无法进行日常活动的发展有关。两名患者均被转至我们的治疗中心接受双侧扣带回前部切开术。术后，两名患者在感知疼痛、心理健康状况和日常功能方面均有显著的逐步改善。
双侧扣带回前部切开术可能是药物难治性神经性疼痛的一种替代治疗方法，尤其适用于同时患有抑郁症的患者。
