国际助残疼痛培训.pptVIP

Neuro-related Pain神经疼痛 Pain Course 疼痛培训 2009.09.10-11 Aim of Training 培训目标 To have an understanding of the pain mechanisms that are associated with some neurological conditions 理解与某些神经情况相关的疼痛机制 To know the treatments currently available to reduce/improve the pain了解当前可用的用于减轻或改善疼痛的治疗方法 Open discussion/problem-solving related to your experience of neurological patients who present with pain 自由讨论/神经病人疼痛处理的相关经验 Signs of Neuro-related Pain神经疼痛的征兆 Dysesthesia (spontaneous abnormal sensation) 感觉迟钝（自发的异常感觉） Allodynia (abnormal sensation to external stimuli) 异常疼痛（对外部刺激感觉异常） Hyperalgesia (an increased response to a stimuls that is normally painful)痛觉过敏（对刺激的痛感比正常水平高） Neuropathic pain descriptions神经疼痛描述: “burning, tingling, coldness, pinsneedles, numbness, stabbing, shooting, electric shock”灼烧、刺痛、寒冷、针刺、麻木、刺伤、阵痛、电击 Neuropathic pain神经疼痛 Central neuropathic pain中枢神经疼痛 - example: occurs in SCI, CVA, Multiple Sclerosis 举例：发生在SCI、脑血管意外和多发性硬化 Peripheral neuropathic pain 周围神经疼痛 - example: occurs in Diabetes, HIV-related neuropathy, Herpes Zoster virus, toxins, nutritional deficiencies 举例：发生在糖尿病、艾滋病相关的神经疾病、带状疱疹病毒、毒素、营养缺乏 4 Main Types主要类型: Polyneuropathy多发性神经病 Mononeuropathy单发性神经病 Mononeuritis multiplex多发性单一神经炎 Autonomic neuropathy自主神经病变（植物神经病变） Complex Regional Pain Syndrome复杂性区域疼痛综合征 CRPS-1: No evidence of nerve damage 1型：没有神经损伤的证据 CRPS-2: Evidence of nerve damage 2型：神经损伤的证据 Complex Regional Pain Syndrome复杂性区域疼痛综合征 Characterised by有如下特征: Pain: Shoulder and Wrist/hand疼痛：肩关节、手腕或手 Sensory disturbances (allodynia) 知觉障碍/紊乱（异常性疼痛） Sympathetic hyperactivity交感神经亢进 Motor impairment (weakness)运动残损（肌力减弱） Sympathetic dysfunction 交感神经障碍 Oedema 水肿 Vasomotor changes (changes in skin bloodflow)血管收缩变化（皮肤血流变化） Trophic changes营养变化 Osteoposis on x-ray X片显示骨质疏松 Complex Regional Pain Syndrome复杂性区域疼痛综合征 感觉异常 血管异常 水肿和异常流汗 运动或营养变化 自发性疼痛 机制性痛觉过敏 感觉异常 深层躯体痛觉过敏 血管舒张 血管收缩 皮肤温度不均 皮肤颜色改变 肿胀 多汗症 少汗症 运动功能减弱 震颤 张力障碍 协调缺陷 指甲、毛发变化 皮肤萎缩 关节僵硬 软组织变化 Treatment of CRPS复杂性区域疼痛综合征的治疗 Int