腰椎间盘的针刀治疗

Results from mechanical, thermal, or chemical excitation of nociceptors Mediated at nociceptors widely distributed in skin, subcutaneous tissue, bone, muscle, connective tissue, vasculature, and viscera Pain described as dull, aching, throbbing, sometimes sharp
Pharmacology of chronic pain
Medications for Neuropathic Pain
Opioids
Anticonvulsants
Antidepressants
Adjuvant Medications
Medication Combinations
Interventional pain therapy
Pain as the
th 5
vital sign
JACHO 2000 T, HR, BP, RR, Pain
Vital life functions Variations indicate or reflect both physiological and psychological health
Therapeutic
methods
⑧Physiotherapy ⑨Biofeedback ⑩Psychotherapy ⑾Massage ⑿Operative therapy ⒀Injection of collagenase treat LDH ⒁Destruction of spinal nerve with the injection of alcohol or other destructive drugs
The 10th world congress on pain ( Sandiago 2002)suggested that pain should be the fifth major vital sign concurrently with blood pressure, pulse, heart rate and breathing.
But to be modulated and controlled
Pain Management and NOT Pain Cure
Quality of Life
Minimize the pain & suffering Restoration of Functions
Therapeutic
Spine-Cath
IDET
Arthrocare System
DeKompressor
Minimally invasive therapy for LBP
Intradiscal Chemonucleolysis
Chymopapain Collegenase
Percutaneous endoscopic discectomy APLD (automatic percutaneous laser discectomy) Radiofrequency thermocoagulation nucleoplasty Coblation nucleoplasty DeKompressor nucleoplasty
Interventional pain therapy

Nerve Block Chemoneurolysis Cryoneurolysis
Deep Brain stimulator Intraspinal drug delivery system Catheter
Nociceptive sensitization of peripheral nervous system
Nociceptive sensitization of central nervous system
The imprint of pain in CNS
Definition
Chapter 2
1950
Dr. John J Bonica
1953
Textbook “pain” By Bonica
1973
International Association for the Study of Pain IASP
The Journal is devoted exclusively to subject, and lot of textbooks of pain is published.

Neuropathic - imprinted/aberrant activity of the PNS/CNS
Most chronic pain is neuropathic Opioid-resistant e.g., radiculopathy, CRPS (RSD), PHN
Nociceptive Pain (Somatic/Visceral)
Part 13
Pain Therapy
Content
Introduction Classification The Basic Theropeutics Clinical Application of Local and Nerve Block and Definition
Chapter 1 Introduction and Definition
CHRONIC PAIN
Who Should We Ask
To take care of these patients’ Pain Problem
Chronic Persistent Pain
No longer serves as a Warning But Causes Disability like other Chronic Disease
Leabharlann Baidu
Neuropathic Pain

Results from actual damage to nerve or altered function of a nerve May be mediated by N-Methyl-D-Aspartate receptor Pain described as burning, tingling, shooting, electric-like, etc.
Thermoneurolysis (RF)
Pulsed RF neuromodulation Spinal cord stimulator Peripheral nerve stimulator
Pump
Biopump (chromaffin cell implant) Gene Therapy
Neuropathic Pain
Imprinted
pain of PNS and/or CNS Lacks physiologic function Opioid-resistant Essentially impossible to treat completely Goal is to decrease pain while improving function
Pain as a warning signal
Gate Control Theory of Pain
• Wall & Melzack, 1965
• ‘Spinal gate’ in the dorsal horn of spinal cord
• Pain neuromodulation
Chronic Pain
Radiofrequency Lesioning
Low Back with Lumbar Disc Disease
For low back pain
Laminectomy And Discectomy
Epidural Steroid Injection
Chemonucleolysis
What dose the pain management specialist do?
Chapter 3 The Basic Therapeutics
The goal of Pain Management
Chronic Pain frequently cannot be eliminated



May be opioid-resistant or require higher doses.
Krames E. J Pain Symp Manage 1996;11(6):333-352. Winkelmuller M, Winkelmuller W. J Neurosurg, 1996;85:458-467.
Types of Pain I: IASP

Nociceptive - consequence of tissue injury
Musculoskeletal, Visceral Opioid-responsive e.g., post-op pain, fractures, appendicitis
methods
①Drug ②Local and nerve block ③Epidural therapeutics ④Stellate gangline block ⑤Pituitary destruction ⑥Endocrainials injection of morphine ⑦Stimulation
Pain Treatment Ladder
Analgesics
Physical
therapy Interventional pain management Surgery Chronic opioids Spinal cord stimulation, pump Neurolysis
Pain: Time for Re-Evaluation
The Debate
Pain as a warning signal Vs Pain as a chronic disease
World Congress on Pain
q. 3. year
The 9th World Congress was held in Vienna,1999 The 10th World Congress was held in San Diego, 2002 The 11th World Congress was held in Sydney,2005
Classification
Chronic
headache Neuralgia and peripheral neuropathy Acute and chronic soft tissue damage Rachiogenous pain Joint pain Viceral pain Painful peripheral vascular disorders Malignant pain
For Compression Fracture of Spine
Failed Back (Surgery) Syndrome
Epidural Adhesion
Nerve Root Adhesion Arachnoiditis
Spinal Cord Stimulator
Intraspinal Analgesia:



Opioid-responsive
Krames E. J Pain Symp Manage 1996;11(6):333-352.
Nociceptive Pain
Nerve
ending initiated Serves initial protective function May resolve with healing of tissue damage Opioid-responsive