教育演講4:疼痛的精準醫學:診斷、評估與治療
Precision medicine of pain: diagnosis, assessments, and therapy

程 序 表

E4-4
疼痛介入治療的新發展
溫永銳
中國醫藥大學附設醫院疼痛中心

  過去十年來,慢性疼痛治療最令人興奮的一件事,是各類「介入性疼痛治療」的普及化。這些技術的進步,不僅提高了疼痛控制的療效,也重新定義及深入了解疼痛神經的機制。除了許多種嶄新不同影像引導技術及神經疼痛學理論,有越來越的注意力開始集中在各種的神經調控刺激器(Neuromodulation)。
  我的演講將介紹目最新的脊髓刺激器(SCS)及周邊神經刺激器(PNS)的應用,包括:以植入式電刺激治療不同疾病,如:椎板切除後症候群、複雜性局部疼痛症候群、頑固型內臟型疼痛、周邊血管缺血性疼痛、偏頭痛、帶狀皰疹神經痛,及周邊神經痛,及應用在身體不同的部位 如:頭、頸、肩、四肢。同時,我將介紹市場上應用的各種SCS, PNS等產品。特別值得注意的是,新發展的暫時性植入式PNS具有幾項臨床優勢,如:可以超音波引導植入,可在門診執行,具有低風險、低併發症等優點。這些進步,讓神經調控擁有更大的應用空間及更多的適應症,也吸引更多學者進行深入的臨床及基礎研究,未來可能成為慢性疼痛控制重要的武器之一。
  What exciting, for the past few years, is a beginning era of widely used “Interventional Pain Management” technology for treatment of intractable pain diseases. These approaches dramatically improve the clinical efficacy and is leading to new concepts of neuromodulation. In addition to the development of many novel spinal cord stimulations (SCS), more and more focuses are paid on peripheral nerve stimulations (PNS). My presentation will include a unique compilation of the latest theoretical and practical information for electrical stimulation of the spinal cord and peripheral nerves, covering the use of SCS and PNS in specific indications such as failed back surgery syndrome, complex regional pain syndrome, refractory visceral pain, peripheral vascular ischemic pain, migraine, postherpetic neuralgia, and peripheral neuropathic pain as well as in specific body parts such as head and neck, shoulder, and extremities. Furthermore, I will introduce different types of SCS and PNS in the market. Of particular attention, recent developed percutaneous PNS could be easily introduced under ultrasound guidance, at the out-patient setting, and found to be at low risks and minimal complications. These advancement of novel neurostimulation techniques facilitates a broader range of clinical application, more indications, and has attracted increasing in-depth clinical and basic researches.