脊椎手术后的慢性疼痛:对病变发生,新疗法和预防性治疗的洞察
Qichao Wu1,2, Xiang Cui1, Leo C Guan3
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA.
Journal of orthopaedic translation
|October 12, 2023
概括
脊柱手术 (CPSS) 后的慢性疼痛是复杂的,难以治疗的. 了解其原因,并采用多模式,患者特定的治疗方法,包括早期干预,可以改善结果.
科学领域:
- 神经外科 神经外科
- 疼痛医学 医学 疼痛医学
- 翻译研究是翻译研究.
背景情况:
- 脊柱手术后的慢性疼痛 (CPSS) 影响8-40%的腰部手术患者.
- 具有持续的下背部和/或辐射腿部疼痛的特征,CPSS带来了重大管理挑战.
研究的目的:
- 审查CPSS的病因学和当前的治疗选择.
- 增强对CPSS病原学的理解,以改善临床策略.
- 确定潜在的新疗法目标和未来的研究方向.
主要方法:
- 在PubMed和MEDLINE/OVID的综合文献搜索.
- 叙述性审查侧重于CPSS的机制研究和临床证据.
- 分析对CPSS有助于形成的结构性和非结构性因素.
主要成果:
- CPSS病因通常是多因素的,涉及结构性 (纤维化,痕) 和非结构性因素 (炎症,神经元敏感化,质激活,心理因素).
- 目前对CPSS的治疗方法往往不够,这凸显了对新方法的需求.
- 混合病因在CPSS患者中很常见,需要个性化治疗计划.
结论:
- 建议采用全面的,针对患者的,多模式的方法来管理CPSS.
- 早期的手术内干预可以降低CPSS的风险或预防CPSS的出现.
- 对基于机制的疗法的进一步研究对于管理和预防CPSS至关重要.
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