神经电刺激治疗慢性头面部疼痛：综述（二十一）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Antony AB,  Mazzola AJ,  Dhaliwal GS, et al. Neurostimulation for the Treatment of Chronic Head and Facial Pain: A Literature Review[J]. Pain Physician, 2019, 22(5):447-477. 本次学习由陈阳住院医师主讲。

Similarly, in 2016, Lambru et al reported on the use of paresthesia-free HF10 SCS for intractable headache disorder. The target for continuous stimulation was also the dorsal columns at C2-C3. This population of 7 patients included 4 with CM, 1 with chronic CH, and 2 with chronic short-lasting unilateral neuralgi-form headache attacks with autonomic symptoms. The 4 CM patients all exhibited at least 50% reduction in headache frequency and/or intensity; the chronic CH patient reported a significant reduction in attack duration. Overall range of follow-up was from 12 to 42 months. Two patients underwent revisions secondary to lead migration. Secondary to this promising data, we are hopeful that HF10 SCS will continue to prove to be an effective headache treatment.

同样，2016年，Lambru等人报道了利用无感觉异常的HF10 SCS治疗难治性头痛疾病。连续刺激的靶点也是C2-C3的背柱。这7名患者包括4例CM、1例慢性CH和2例伴自主神经症状的慢性短时单侧神经样头痛发作。4例CM患者的头痛频率和/或强度均降低了至少50％；慢性CH患者的发作持续时间显著降低。总体随访时间为12个月至42个月。2例患者因电极移位再次手术。由于较好的实验数据，我们希望HF10 SCS将继续证明可有效治疗头痛。

Reported in 2011, Tomycz et al reviewed the literature for cervicomedullary junction SCS to allevi-ate head and facial pain. They conclude that patients with trigeminal deafferentation pain, trigeminal neuropathic pain, and PHN may respond favorably, and patients with occipital neuralgia are likely not to benefit. A single-center retrospective case series analyzed 12 patients who underwent HCSCS for facial pain syndrome (the vast majority with trigeminal neuropathy, one with TN, and 2 with neuropathic facial pain). The authors conclude that > 60% of patients had effective pain relief. Similarly, in 2018, Velásquez et al retrospectively reported on 12 patients diagnosed with trigeminal neuropathic pain at varying and sometimes multiple nerve divisions (42% with ophthalmic, 75% with maxillary, and 33% with mandibular). Mean follow-up period was 4.4 years. The average change in Numeric Rating Scale was from a baseline of 7 to postimplantation of 3. There was a 57.1% overall pain reduction, however long-term failure rate was 25% with 2 patients not having relief and 1 patient having a late biological failure at one year. Access for implantation was performed by a midline partial C1 laminectomy to place the epidural paddle slightly lateralized to the affected side. In 75% of patients, leads were placed at C0-C1 and in 25% the upper contact was below C1. Tonic stimulation was used in all patients. Mean follow-up period was from 0.3 to 21.1 years, with an average of 4.4 years. During this period there were a total of 19 system revisions mostly related to not ideal positioning, malfunction, or disconnection.

Tomycz等人于2011年发表综述，回顾了颈髓交界处SCS减轻头面部疼痛的文献。他们得出结论，三叉神经去传入疼痛、三叉神经病理性疼痛和PHN的患者可能反应良好，枕神经痛患者不一定能获益。一项单中心回顾性病例系列分析了12例因面痛综合征而接受HCSCS治疗的患者（绝大多数为三叉神经病理性疼痛，1例为TN，2例为神经性面痛）。作者得出结论，> 60％的患者有效。同样，在2018年，Vevasquez等人回顾性分析了12例诊断为三叉神经病理性疼痛的患者，他们疼痛在不同的分支或多个分支分布区（眼支占42％，上颌支占75％，下颌支占33％）。平均随访期为4.4年。NRS的平均变化从基线的7到植入后的3。总体疼痛缓解率为57.1％。但是，长期失败率为25％，其中2例患者无缓解，1例患者1年后出现迟发性生物故障。中线部分C1椎板切除后将电极植入硬膜外稍微偏向患侧。75％的患者电极放置在C0-C1处，而25％的患者电极上端低于C1。随访期从0.3至21.1年，平均4.4年。在此期间，总共进行了19次系统修复，其中大部分与定位不理想、故障或失联有关。

Furthermore, Papa et al reported a case report on successfully using SCS to treat a case of refractory Eagle’s syndrome to both conservative treatments and surgery. 10 KHz SCS was placed between C2 and C7. Patient’s pain relief went from 10 to 4, and there was complete relief from a prior persistent foreign body sensation in the throat. Because of the patient’s delayed diagnosis of over 20 years, the authors suggest the pain had become centralized. Although clearly it has been demonstrated effective in small studies and case reports, larger studies showing long-term efficacy for high cervical leads to treat headache and facial pain are lacking.

此外，Papa等人报道了一个成功使用SCS治疗保守和手术难治性Eagle综合征的病例报告。在C2和C7之间放置了10 KHz SCS。病人的疼痛从10减轻到4，并且先前喉咙中持续存在异物感完全缓解了。由于患者延迟诊断超过20年，作者认为疼痛已存在中枢敏化。尽管在小型研究和病例报告中已经证明了它的有效性，但仍缺乏大型研究表明高颈段电极治疗头痛和面部疼痛的长期疗效。