脊髓电刺激术的研究现状及其在难治性疼痛中的临床应用

The application of spinal cord stimulation to treat refractory pain

背景难治性疼痛因对传统药物、物理等常规治疗手段不敏感而成为长期困扰患者的顽疾。目前脊髓电刺激（spinal cord stimulation，SCS）已经在临床上用于治疗难治性疼痛，其有效性及安全性均得到多方验证。目的对SCS的研究现状进行综述，详细介绍SCS在难治性疼痛的临床应用，为难治性疼痛提供新的治疗策略。内容介绍SCS的原理、手术方法及并发症，总结SCS在难治性疼痛的临床应用、SCS患者的选择与禁忌证。趋向SCS用于治疗难治性疼痛是一种安全、有效的辅助疗法，它的临床效果肯定，应用广泛，今后需要进一步研究，使其更好地运用于临床。

Background Refractory pain is a chronic disease that is not responsive to conventional medications and physical therapy. Spinal cord stimulation （SCS） has been recently employed to treat refractory pain, and its efficacy and safety have been verified. Objective This article aims to review the clinical application of SCS in the treatment of refractory pain. Content The electrode for SCS is inserted into epidural space to stimulate spinal dorsal fasciculus and sensory neurons. The overall effect of SCS is blocking pain signal transduction probably by enhancing the release of ＂/-aminobutyric acid, but inhibiting the release of glutamate in the spinal cord dorsal horn. Refractory pain has been reported in failed back surgery syndrome, complex regional pain syndromes, painful diabetic peripheral neuropathy, and postherpetic neuralgia. In 80% of patients with refractory pain, SCS shows therapeutic efficacy much better than conventional treatments, and improves sleeping, as well. Trend SCS is a safe and effective method for the treatment of refractory pain.