神經調控的觀念和疼痛介入性治療的新進展

Neuromodulation Concept and the Novel Advances of Interventional Pain Therapy

近年來對慢性疼痛的研究越來越豐富，雖然仍無法完全解除病人的疼痛，但治療手段及觀念更完備。除了止痛藥、復健、手術、及注射阻斷外，現在更加入神經調控（neuromodulation）技術，將非藥物、非破壞性、低侵入性、長期止痛為目標的電刺激裝置植入體內。雖然傳統的脊隨刺激器（spinal cord stimulator）已將近50年，但是近10幾年來發展出許多新的刺激技術，如：高頻刺激（high-frequency）、爆發型（burst）刺激、封閉迴路型（closed-loop）刺激、差異標靶多路（differential targeted multiplexed）刺激等，不僅提高止痛效率，改善情緒和生活機能，臨床的應用也更廣泛。又如迷走神經刺激器用於慢性頭痛、各種暫時或永久的周邊神經刺激器，都將神經調控觀念更全面地運用在慢性疼痛治療上，將逐漸替代嗎啡類止痛藥，成為治療頑固型疼痛病人的新趨勢及新主流。

In recent years, researches on chronic pain are getting more abundant. Although the patient's pain cannot be completely relieved so far, the means and concept of pain management are becoming more and more complete. In addition to traditional pain relief drugs, rehabilitation, surgery, and injection block commonly used by pain physicians, the technology of neuromodulation is included for treatment by implantation of a non-drug, nondestructive, low-invasive, and long-term effective electrostimulation devices in body. Taking spinal cord stimulator (SCS) as an example, although traditional low-frequency SCS have been utilized for nearly 50 years, more and newer stimulation concepts, parameters, and paradigms have been developed in the past decade, such as: highfrequency SCS (HF SCS), burst SCS, closed-loop SCS, differential targeted multiplexed (DTM) SCS, etc., not only improve the efficiency of pain relief, but also control emotion, enhance daily activities, and have a wider range of clinical applications. In addition, such as the application of vagus nerve stimulators (VNS) to chronic headache, and emergence of various permanent or temporary implantable peripheral nerve stimulators (PNS) for different peripheral neuropathic pain or degenerative pain, the concept of neuromodulation has been widely applied for treatment of chronic pain. This will gradually replace opioid painkillers and become a new trend and new mainstream in the treatment of intractable pain patients.