运动皮质电刺激术治疗顽固性神经病理性疼痛

摘要

目的 研究运动皮质电刺激术(motor cortex stimulation,MCS)治疗顽固性神经病理性疼痛的临床应用.方法 脑卒中后疼痛9例,脊髓损伤后疼痛3例,幻肢痛2例.均行MCS治疗,同期植入刺激电极和脉冲发生器.采用视觉模拟疼痛评分(VAS)评价疗效.结果 术后疼痛均不同程度减轻,1个月以内镇痛疗效较满意,VAS评分较术前显著降低(P＜0.01).随访1～5年,多数病人镇痛效果出现波动,调整刺激参数后仍能获得镇痛疗效,疼痛较术前减轻10％～90％,脑卒中后疼痛的长期疗效要好于脊髓损伤后疼痛和幻肢痛.结论 MCS是治疗神经病理性疼痛的一种新方法,具有疗效肯定、可调节等优点,术后刺激参数的调整对疗效的影响至关重要.%Objective To study the clinical application of motor cortex stimulation (MCS) for intractable neuropathic pain. Methods Fourteen patients suffering from intractable pain secondary to different origins, including post-stroke pain in 9, spinal cord injury in 3 and phantom limb pain in 2, were treated by MCS. The MCS electrodes were successfully implanted under general anesthesia. Then the free electrodes were connected to the extension leads, which were connected to a pulse generator by means of a one-stage procedure. Clinical evaluation was based on the visual analogue scale (VAS). Results All the patients were relieved of their preoperative pain after the operation. The short-term (< 1 month) follow-up results indicated a significant reduction in patients' VAS (P < 0.01). In the follow-up periods from 1 to 5 years, the most patients needed to be adjusted of the stimulation parameters in order to achieve better pain relief. The patients had experienced pain relief from 10% to 90%. The better effectiveness of pain control was obtained in the patients with post-stroke pain than the patients with spinal cord injury and phantom limb pain. Conclusion MCS is a new safe, adjustable, and efficient therapeutic technique for treating intractable neuropathic pain, but adjustment of the stimulation mode and parameters is essential for satisfactory pain relief.