Tsubokawa T, Yamamoto T, Katayama Y, Nishimoto H, Hirayama A, Shibuya H
No Shinkei Geka. 1984 Mar;12(4):459-67.
Chronic implantation of a stimulating electrode in the thalamic relay nucleus (11 cases), in the periaqueductal gray (1 case) and in the internal capsule (2 cases) was performed in fourteen cases which suffered from intractable pain. All these cases could get pain relief at least initial two months. Ventricular fluids were collected before and after stimulation with optimal combination of parameters, and measurements of beta-endorphin were performed by radio-immunoassay. Intrathecal morphine (1mg) injection was performed in eight cases. Cerebrospinal fluids were collected by lumbar tap before and 24 hours after morphine injection. beta-endorphin immunoreactivity was measured by the same method. Pain relief was judged to be excellent if the patient so claimed, and if he discontinued analgesics. Pain relief was thought to be good when it was not completely controllable by stimulation but was sufficiently improved that the patient could do without analgesics. It was thought to be fair when patient could not discontinue analgesics, and poor when patient could not get pain relief. We usually attempt to prevent the stimulation-tolerance by administration of the monoamine precursors , i.e., 1-dopa and 1-tryptophan, on the basis of the experimental observation reported previously. In somatogenic pain patients, the thalamic relay nucleus stimulation was performed in 7 cases (excellent; 3, good; 1, fair; 3) and the periaqueductal gray stimulation in one case (good).(ABSTRACT TRUNCATED AT 250 WORDS)
对14例顽固性疼痛患者进行了慢性植入刺激电极手术，其中将刺激电极植入丘脑中继核（11例）、导水管周围灰质（1例）和内囊（2例）。所有这些病例至少在最初两个月都能缓解疼痛。在以最佳参数组合进行刺激前后收集脑室液，并通过放射免疫测定法测量β-内啡肽。8例患者进行了鞘内注射吗啡（1mg）。在注射吗啡前及注射后24小时通过腰椎穿刺收集脑脊液。用相同方法测量β-内啡肽免疫反应性。如果患者声称疼痛缓解且停用了镇痛药，则判定为疼痛缓解良好。当疼痛不能通过刺激完全控制但有足够改善以至于患者可以不用镇痛药时，认为疼痛缓解良好。当患者不能停用镇痛药时，认为疼痛缓解一般；当患者疼痛未缓解时，认为疼痛缓解差。基于先前报道的实验观察结果，我们通常尝试通过给予单胺前体，即左旋多巴和色氨酸，来预防刺激耐受性。在躯体性疼痛患者中，7例进行了丘脑中继核刺激（良好3例、一般1例、差3例），1例进行了导水管周围灰质刺激（良好）。（摘要截断于250字）
