復發性坐骨神經痛病患的多模式止痛以減少嗎啡類用量

Opioid-sparing multimodal analgesia for recurrent sciatic pain

坐骨神經痛主要是因為腰椎間盤突出，退化性椎間盤疾病以及腰椎管狹窄症所導致的。典型症狀包含臀部及延伸到腿部的疼痛。建議的治療方法包括藥物治療（抗發炎藥、肌肉鬆弛劑、嗎啡類止痛藥、三環抗憂鬱劑、抗癲癇藥物）、物理治療、類固醇注射以及手術。一位71歲的男性病患因為口腔手術後嚴重且反覆發作的坐骨神經痛，由耳鼻喉科醫師轉介過來，他的持續性疼痛達到疼痛分數8/10，痛覺從後背延伸到大腿，並伴隨著間斷性的跛行。轉介前的用藥是每天oxycodone 20毫克。腰部脊椎核磁照影顯示他有腰椎第五節及薦椎第一節間滑脫，同時腰椎第三及第四節、第四及第五節與腰椎第五節及薦椎第一節間都有椎間盤突出。我們為他施打尾椎硬膜外類固醇注射並減少oxycodone一半使用量至每天10毫克。在之後9個月的追蹤上，他的疼痛指數大幅下降，生活品質也有長足進步。我們認為這樣的多模式止痛方案可以用在於減少嗎啡類止痛藥的使用量以及有效改善慢性坐骨神經痛，特別是應用在那些不願意或是無法接受手術的病患們身上。

Sciatic pain is often caused by a lumbar herniated disc, degenerative disc disease or spinal stenosis. Typically, pain starts in the buttocks and runs down the back of the leg to the foot. It is often treated with medications (anti-inflammatory drugs, muscle relaxants, opioids, tricyclic antidepressants, or antiepileptic drugs), physical therapy, steroid injections and surgery. Herein we report a case of severe recurrent right sciatic pain in a 71-year-old man referred to our pain clinic The patient presented persistent pain (numeric rating scale 8/10) originating from the lower back running down into the right thigh and intermittent claudication. His otolaryngologist had prescribed him 20mg oxycodone per day. MRI of the lumbar spine revealed a grade 1 spondylolisthesis at L5-S1, degenerative disc disease at L5-S1 and herniated discs at L3-4, L4-5 and L5-S1. The patient received one caudal epidural steroid injection and was prescribed 10mg oxycodone per day. The patient’s pain intensity and life quality improved greatly during a 9 month follow-up period. Physicians may want to consider multimodal analgesia instead of opioids to resolve chronic sciatic pain in patients unwilling or unable to receive surgery.