Neuropathic pain refers to pain caused by primary damage and dysfunction of the nervous system. It is a type of chronic and spontaneous pain, mostly caused by sciatica and postherpetic neuralgia (commonly known as “生蛇” in Hong Kong).
對於神經性疼痛,現時一般藥物治療相對效用不大,傳統止痛藥例如撲熱息痛 (Paracetamol) 或一些非類固醇消炎藥都無法有效地緩和痛楚。
一些精神科醫生提出使用一些精神科藥物來治療,例如三環抗抑鬱藥 (TCA) 或抗癲癇藥,雖然在部分病例中這些藥物比傳統止痛藥更為有效,但這些精神科藥物帶來很多副作用,治療效果成疑,並且未被美國和歐洲廣泛使用,所以患者在採用藥物治療前,應先考慮清楚。
對於無法以藥物緩解的神經性疼痛,腦磁激是一種有效而且無創的技術,定位導航系統透過把腦磁激技術和3D腦成像相結合,可以準確有效地調節運動皮層 (Mortor cortex) 中的神經活動,從而調節疼痛感,用於緩解慢性難治的神經性疼痛有很大的幫助。
專家指出透過 3D腦成像能準確判斷腦部運動皮層中需要刺激的部位,令腦磁激可以真正發揮顯著的鎮痛作用,可見病人在導航腦磁激治療試有臨床受益。
參考資料
Haanpää, M. & Treede, R.D. (2010). Diagnosis and classification of neuropathic pain. Pain: Clinical Updates,18(7).
Lefaucheur, J.P. et al. (2014). Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol, 125(11):2150-206.https://www.ncbi.nlm.nih.gov/pubmed/25034472
Nurmikko,T. et al.(2016). Motor Cortex Reorganization and Repetitive Transcranial Magnetic Stimulation for Pain-A Methodological Study. Neuromodulation,19(7):669-678.
Treede, R.D., Jensen, T.S., Campbell. J.N., Cruccu, G., Dostrovsky, J.O., Griffin, J.W., Hansson, P., Hughes, R.,Nurmikko, T.,& Serra J.(2008). Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology,70,1630–5.
Other
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Nurmikko TJ, Sacco P 5th International Symposium on Navigated Brain Stimulation in Neurosurgery Charité – Universitätsmedizin Berlin (Organizer) 2014 June; 32-36