Hassenbusch S J, Stanton-Hicks M, Covington E C
Department of Neurosurgery, M.D. Anderson Cancer Center Houston, Texas, USA.
Acta Neurochir Suppl. 1995;64:109-15. doi: 10.1007/978-3-7091-9419-5_24.
The relative roles of spinal cord stimulation and the spinal infusion of opioids in the treatment of chronic, non-cancer lower body pain remains unclear. This report contains a retrospective analysis of patients with chronic lower body, neuropathic pain and treated over a 5 year period. Unilateral leg and/or buttock pain was treated initially with spinal stimulation and bilateral leg or mainly low back pain was treated initially with spinal infusions. 26 patients received spinal stimulation. Pain relief was > or = 50% in 16 (62%) with increased activity levels. Stimulator coverage was most difficult or failed in patients with buttock pain. 16 patients received long-term spinal infusions. Pain relief was > or = 50% in 2 (13%) but 25-49% in another 8 (50%) with stable infusion doses and was best in patients requiring low-dose (< 1 mg/h morphine intrathecal) infusions in the trial period. The review indicates that spinal infusions may be best for bilateral or axial pain that has not responded to spinal stimulation. Clonidine appears to be an alternative in high-dose morphine patients. New diamond-shaped electrode and dual quadripolar arrays appear to be very helpful for back, buttock, and/or bilateral leg pain patterns.
脊髓刺激和脊髓内注入阿片类药物在治疗慢性非癌性下半身疼痛中的相对作用仍不明确。本报告包含对慢性下半身神经性疼痛患者进行的为期5年的回顾性分析。单侧腿部和/或臀部疼痛最初采用脊髓刺激治疗，双侧腿部疼痛或主要为下背部疼痛最初采用脊髓内注入治疗。26例患者接受了脊髓刺激治疗。16例（62%）疼痛缓解≥50%，活动水平有所提高。对于臀部疼痛患者，刺激器覆盖最为困难或失败。16例患者接受了长期脊髓内注入治疗。2例（13%）疼痛缓解≥50%，但在另外8例（50%）患者中，在稳定注入剂量下疼痛缓解25%-49%，且在试验期内对需要低剂量（鞘内吗啡<1mg/h）注入的患者效果最佳。该综述表明，脊髓内注入可能最适合对脊髓刺激无反应的双侧或轴向疼痛。可乐定似乎是高剂量吗啡患者的一种替代药物。新型菱形电极和双四极阵列似乎对背部、臀部和/或双侧腿部疼痛模式非常有帮助。
