Division of Algology, Department of Neurology, Adnan Menderes University Faculty of Medicine, Aydın, Türkiye.
Division of Algology, Department of Anesthesiology and Reanimation, Adnan Menderes University Faculty of Medicine, Aydın, Türkiye.
Agri. 2022 Oct;34(4):316-321. doi: 10.14744/agri.2020.29053.
Ischemic pain is the main symptom of a group of diseases that result in inadequate blood flow to the extremities and ischemia. In this symptomatology, two major diseases are distinguished: Critical vascular disease and Raynaud's phenomenon. Critical vascular disease background of atherosclerosis caused by diabetes mellitus or hypertension. Raynaud phenomenon is divided into primary and secondary form. The primary form is due to vasospasm and there is no underlying cause. Secondary form is associated with underlying connective tissue or rheumatic diseases, peripheral vascular diseases such as thromboangitis obliterans (Burger's disease). Clinical findings in Raynaud's disease are vasomotor changes with cold exposure such as bruising, coldness, painful paresthesias, and ulcers due to chronic ischemia. Clinic presentation in critical ischemic disease is intermittent claudication for earlier stage and resting pain, gangrene, necrosis, and trophic changes were added in advanced stages. The treatment of the Raynaud 's disease in early stage is medical and conservative. In case of advanced stage ischemic vascular disease, medical treatment resistant pain, insufficient response to endovascular treatment, and inoperabl cases, interventions such as sympathectomy and spinal cord stimulation (SCS) can be applicable. SCS reduces vascular resistance through vasodilator mediators and increases blood flow. SCS also suppresses sympathetic vasoconstriction, increases tissue vascularity, reduces tissue damage, provides ulcer healing and pain reduction. In this report, we demonstrated that persistent Raynaud's disease and advanced stage Burger's disease were successfully treated with SCS.
缺血性疼痛是一组导致四肢血液供应不足和缺血的疾病的主要症状。在这种症状学中,有两种主要的疾病:严重的血管疾病和雷诺现象。严重的血管疾病是由糖尿病或高血压引起的动脉粥样硬化背景。雷诺现象分为原发性和继发性。原发性是由于血管痉挛,没有潜在的原因。继发性与潜在的结缔组织或风湿性疾病、血栓闭塞性脉管炎(伯格病)等周围血管疾病有关。雷诺病的临床发现是在寒冷暴露下出现血管舒缩变化,如瘀伤、寒冷、疼痛性感觉异常和慢性缺血引起的溃疡。在严重缺血性疾病的早期阶段,间歇性跛行和休息痛,晚期则出现坏疽、坏死和营养变化。雷诺病的早期治疗是药物和保守治疗。对于晚期缺血性血管疾病,如果药物治疗无效疼痛、对血管内治疗反应不足和无法手术的情况下,可以考虑交感神经切除术和脊髓刺激(SCS)等干预措施。SCS 通过血管扩张剂介质降低血管阻力并增加血流量。SCS 还抑制交感神经血管收缩,增加组织血管密度,减少组织损伤,促进溃疡愈合和减轻疼痛。在本报告中,我们证明了持续的雷诺病和晚期伯格病可以通过 SCS 成功治疗。