三叉神经痛演示文稿.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Interventional Therapies Interventional treatments for the management of neuropathic pain are well described and available at Pain Clinics throughout Northern Ireland Interventional treatments for neuropathic pain should not be offered to any patient whose pain is not adequately treated with first and second line drugs or for patients with side-effects from medication Invasive treatments should usually be carried out as part of a multidisciplinary treatment plan Patients for spinal cord stimulation or implantable devices may benefit from pretreatment psychological evaluation As with medication, success from interventional therapies may be diminished by concordant psychosocial issues especially depression and anxiety Neuromodulation: A range of therapies which aim to alter the perception of pain by stimulation or inhibition of neural pathways Pulsed radiofrequency: An insulated needle is introduced to the site of nerve injury or the dorsal root ganglion. The heat generated creates a temporary lesion of the nerve tissue. Duration of benefit is often several months. Indications include peripheral nerve injury and radicular pain. Blockade of the sympathetic nervous system: This may provide relief in patients whose neuropathic pain is maintained via this system (Sympathetic-maintained pain). The sympathetic chain can be treated in the cervical, thoracic and lumbar regions with local anaesthetic, thermal radiofrequency or nerve destruction using chemical destruction. Duration of effect depends on method of treatment. （一）药物治疗-1、抗癫痫药 卡马西平：1976 Dunsker Mayfield 奥卡西平(oxcarbazepine)：2001 Ichikawa Lamotrigine Gabapentin （Cheung et al. 1992， Teoh et al. 1995，Mc Cleane 1999） Pregabaline (vertigo, appetite, lethargy, euphoria, somnolence, peripheral oedema , etc) 丙戊酸钠 氯硝西泮 副作用镇静、共济失调、肝损害，偶有再障 嗜睡、眩晕、共济失调、疲乏、严重可惊厥 2、非抗癫痫药 非抗癫痫药物：巴氯芬(baclofen) ，抗精神药哌咪清