中枢性疼痛局所痛の病態と脊髄刺激療法の効果

• 平戸 政史

  群馬大学大学院脳脊髄病態外科

• 高橋 章夫

  群馬大学大学院脳脊髄病態外科

• 渡辺 克成

  群馬大学大学院脳脊髄病態外科

• 風間 健

  群馬大学大学院脳脊髄病態外科

• 好本 裕平

  群馬大学大学院脳脊髄病態外科

書誌事項

タイトル別名

• <b>Spinal cord stimulation therapy for localized central pain </b>

抄録

   We studied the pathophysiology of localized central pain and the surgical result of spinal cord stimulation. There were 10 cases; 7 males and 3 females from 24 to 77 years old. Pain was caused by peripheral nerve injury in one case, spinal cord injury in two cases and cerebrovascular disease (CVD) (thalamic pain) in 7 cases. All cases were treated by epidural spinal cord stimulation and followed from 0.8 to 8.8 years. Sufficient pain relief was achieved in one case of peripheral nerve and spinal cord injury and in 4 cases of CVD. Moderate pain control was achieved in 2 cases of CVD. In one each case of spinal cord injury and of CVD, pain control was ineffective. In cases with thalamic pain, we studied the correlation between the surgical result of spinal cord stimulation and the clinical features, MRI, fluoro-deoxyglucose (FDG)-PET, and somatosensory evoked potentials (SEP) findings before operation. MRI revealed a small to moderate sized lesion on the thalamus or putamen in each case. PET also showed decreased accumulation of FDG on the affected thalamus. In all cases without one fair responder to spinal cord stimulation, we could recognize definite SEP originating in the sensory cortex ipsilateral side to the CVD lesion during contralateral median or posterior tibial nerve stimulation. In the good responders, we could recognize SEP originating in the sensory cortex of the lesion side with less delayed latency or decreased amplitude than in the moderate responders. In this group, test stimulation with low voltage on the spinal cord evoked a sensory effect (paresthesia) over the painful part of the body.<br>   Spinal cord stimulation proved to be an effective treatment for localized central pain. In cases with localized central pain after CVD, we could expect to ameliorate the intractable pain in those cases in which SEP or spinal cord test stimulation revealed that the thalamo-cortical system was preserved.

収録刊行物

• PAIN RESEARCH

  PAIN RESEARCH 23 (1), 35-44, 2008

  日本疼痛学会

キーワード

• Central pain
• Localized pain
• Thalamic pain
• Spinal cord stimulation
• SEP

詳細情報

• CRID: 1390001204366922112
• NII論文ID: 130004839624
• NII論文ID: 10024130748
• NII書誌ID: AN10195934
• DOI: 10.11154/pain.23.35
• ISSN: 21874697
• ISSN: 09158588
• Web Site: https://www.jstage.jst.go.jp/article/pain/23/1/23_5/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2008150548
• 本文言語コード: ja
• データソース種別:
  • JaLC
  • Crossref
  • CiNii Articles
  • KAKEN
• 抄録ライセンスフラグ: 使用不可