Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Good Shepherd Penn Partners, Philadelphia, PA, USA.
Spinal Cord Ser Cases. 2022 Jun 9;8(1):59. doi: 10.1038/s41394-022-00526-6.
Although common in individuals with cancer as well as nerve root compression, neuropathic pain can be difficult to prevent and manage due to the complex pain mechanisms involved in its pathophysiology. Although contrast baths have a long history of use for pain management, there is little known about their efficacy in the acute rehabilitation setting or in patients with cancer related neuropathic pain.
A 54-year-old man with multiple myeloma presented with progressive lower extremity weakness and 8/10 neuropathic pain intensity in both feet due to extensive myelomatous involvement of his lumbar spine. The patient's pain limited his participation in physical therapy despite an extensive pain medication regimen. At the discretion of the patient's physical therapist, contrast bath therapy for this patient was initiated with a reduction in pain intensity to 3/10. This analgesic effect lasted for a period of up to 10 h, which allowed the patient to participate in 3 h of therapy daily and to sleep comfortably.
Contrast baths are a simple and cost-effective therapy that can be performed independently. As demonstrated in this case, they can potentially provide marked improvement in neuropathic pain and, in the acute rehabilitation setting, may enable patients to better participate in intensive physical therapy.
尽管在癌症患者和神经根受压患者中很常见，但由于其病理生理学中涉及的复杂疼痛机制，神经病理性疼痛的预防和管理可能很困难。尽管对比浴在疼痛管理中有很长的使用历史，但在急性康复环境中或在癌症相关神经病理性疼痛患者中，其疗效知之甚少。
一名 54 岁男性患有多发性骨髓瘤，由于腰椎广泛的骨髓瘤浸润，下肢逐渐无力，双脚出现 8/10 的神经病理性疼痛强度。尽管患者接受了广泛的止痛药物治疗，但疼痛限制了他参加物理治疗的能力。根据患者物理治疗师的判断，开始为该患者进行对比浴治疗，疼痛强度降低至 3/10。这种镇痛效果持续长达 10 小时，使患者每天能够进行 3 小时的治疗并舒适地入睡。
对比浴是一种简单且具有成本效益的治疗方法，可以独立进行。正如该病例所示，它们可能会显著改善神经病理性疼痛，并且在急性康复环境中，可能使患者能够更好地参与强化物理治疗。
