Differences in brain structure in patients with distinct sites of chronic pain:A voxel-based morphometric analysis

A reduction in gray matter volume is common in patients with chronic back pain, and different types of pain are associated with gray matter abnormalities in distinct brain regions. To examine differ- ences in brain morphology in patients with low back pain or neck and upper back pain, we investi- gated changes in gray matter volume in chronic back pain patients having different sites of pain using voxel-based morphometry. A reduction in cortical gray matter volume was found primarily in the left postcentral gyrus and in the left precuneus and bilateral cuneal cortex of patients with low back pain. In these patients, there was an increase in subcortical gray matter volume in the bilateral putamen and accumbens, right pallidum, right caudate nucleus, and left amygdala. In upper back pain patients, reduced cortical gray matter volume was found in the left precentral and left postcen- tral cortices. Our findings suggest that regional gray matter volume abnormalities in low back pain patients are more extensive than in upper back pain patients. Subcortical gray matter volume in- creases are found only in patients with low back pain.

从上病下治浅谈“以痛为输”治疗非特异性腰痛的多变性

非特异性腰痛是一种常见疾病,骨盆失衡是引起非特异性腰痛的重要原因。经筋病强调“以痛为输”取穴治疗,然而,仅在疼痛局部“以痛为输”寻找“筋结”并“解结”治疗经筋病不可避免地存在盲目性。本文试图在经筋理论的指导下,从上病下治视角看待非特异性腰痛,并从肌肉失衡角度分析不同腰、骨盆状态与腰痛的关系,通过定位病变肌肉以明确“以痛为输”取穴的方向,探讨“以痛为输”的多变性,探索提高治疗非特异性腰痛疗效的方法。

830nm半导体微激光治疗背肌筋膜炎的临床研究

探讨了830 nm半导体微激光光灸穴位和肌筋膜扳机点(MTr Ps)治疗背肌筋膜炎患者的疗效。预实验收集背肌筋膜炎患者,分为光灸1组4例、光灸2组6例、光灸3组7例和针灸组6例,光灸组采用自主研发的半导体激光光灸仪治疗(中心波长为830 nm,功率密度0.335 W/cm2),时间分别为每次1、2和4 min对患者的养老穴、承山穴背部MTr Ps进行照射;针刺组选用毫针对养老穴、承山穴常规针刺,MTr Ps处斜刺进针贯穿结节得气后留针20 min,中间行针1次。光灸组和针刺组每周治疗3次,一周1个疗程,共治疗4个疗程。正式试验背肌筋膜炎患者38人,治疗方法如预实验光灸3组。采用视觉模糊量表评分(VAS)和简易麦吉尔量表-2(SFMPQ-2)对患者主观症状进行评定,手持式压力测痛仪测定MTr Ps的压力疼痛阈值(PPT)。预实验VAS评分结果表明,除光灸1 min外,其他三组治疗后均有显著减低(P<0.05),组间比较显示,针刺组疗效最好,其次为光灸3组;SFMPQ-评分显示,只有针刺组治疗后有显著减低(P<0.05)。光灸组可显著提高MTr Ps的PPT数值。正式试验结果发现,830 nm微激光可显著降低患者的VAS评分和SFMPQ-2评分,改善患者酸痛、轻压痛和疲惫无力感症状,且可提高肌筋膜扳机点的压力疼痛阈值。该课题组自主研发的半导体激光光灸仪对背肌筋膜炎患者无论从主观评分和半客观的压痛阈值改善方面均有良好的疗效,可被广泛应用于临床。

Ultrasound guided acupotomy in treating rhomboid muscle and serratus posterior superior muscle injury:a case report

Objective:The study intended to show us the effect and safety associated with ultrasound-guidance during acupotomy treatment by a case report.Methods:The research presented a case study using ultrasound-guided acupotomy in back pain.The study took place in the Department of Acupuncture and Moxibustion,China-Japan Friendship Hospital.A 56-year-old woman with paroxysmal right upper back pain for more than 10 years,who was diagnosed as the rhomboid muscle and serratus posterior superior muscle injury.Results:After two acupotomy treatments,the Visual Analogue Score(VAS)of the patient declined from7 to 2.One month later,the pain disappeared and the patient was satisfied with it.Conclusion:Ultrasound guidance can be used to observe the anatomical structures clearly to improve the safety of acupotomy treatment.

针刀松解斜角肌 提肩胛肌为主治疗臂丛上干神经卡压综合征

目的:观察分析臂丛上干神经卡压综合征的小针刀治疗。方法:采用小针刀的方法,在胸锁乳突肌后缘刺入,直接松解斜角肌、提肩胛肌。结果:疗效满意,总有效率95%,合并有颈椎骨性改变者疗效稍差。结论:小针刀能明显改善臂丛上干神经在斜角肌、提肩胛肌内的卡压,缓解疼痛。

北京事业单位女性颈肩、上背部疼痛现状及工作相关因素分析

目的分析北京市事业单位女性颈肩、上背部疼痛现状及工作相关影响因素。方法于2018年6—8月,利用“健康北京人——十年行动终末评估”专项调查数据,对4654名事业单位女职工颈肩及上背部疼痛程度、工作相关因素进行分析,探讨不同程度疼痛特点,为改善事业单位女性肌肉骨骼疾病现状积累经验。结果4654名女性职工中颈肩部和上背部疼痛占67.0%。无序多分类logistic分析显示,加班是不同程度颈肩及上背疼痛的危险因素。中等年龄、高文化程度、年收入在5万元~的职工,高体力要求工作是中度及以上颈肩及上背疼痛的危险因素。工作环境提供健康宣传材料是中度以上颈肩及上背疼痛的保护因素(OR=0.675,95%CI=0.522~0.873;OR=0.434,95%CI=0.311~0.606)。结论北京市事业单位女性颈肩及上背部疼痛状况不容乐观,相关部门应引起重视,提高职工健康意识,改善工作环境,提高其健康水平。