脊髓损伤后神经性疼痛与传统针刺痉挛反应

G. Fizzotti, M. Piccinini, Giovani Fassina, L. Tronconi
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摘要

导读:脊髓损伤(SCI)是最相关的残疾之一。脊髓损伤的典型原因是创伤、疾病或先天性疾病。四肢瘫痪是指肢体和躯干部分或全部丧失使用能力的瘫痪;截瘫是类似的,但不影响手臂。疼痛和痉挛是脊髓损伤的常见后遗症。疼痛和痉挛都可能在脊髓损伤后发病较晚,随着时间的推移而缓慢发展,一旦发展,往往会成为慢性疾病。本文对针刺治疗脊髓损伤后遗症的疗效进行了评价,并对针刺治疗脊髓损伤后遗症的可能机制进行了总结。方法:对30例脊髓损伤后并发神经性疼痛和痉挛的四肢或截瘫患者进行分析。接受过医学针灸训练的神经科医生进行了治疗。在所有的疗程中都使用了一组特定的穴位。参与者在4周的时间内接受了8次针灸治疗。在第一次、第4次和第8次治疗开始时,采用数值评定量表(VAS)(2)和改良Ashworth量表[3]对疼痛和痉挛进行评估。结果:28例患者(93%)针刺治疗2周后疼痛强度和痉挛症状均有改善。治疗效果持续到治疗第8周。然而,15名患者(53.5%)报告在针灸治疗2个月后痉挛和疼痛增加。结论:使用指定的穴位组进行针灸治疗可以减轻脊髓损伤患者的疼痛强度和痉挛。
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Neuropathic Pain and Spasticity Response to Traditional Acupuncture after Spinal Cord Injury
Introduction: One of the most relevant disabilities is caused by spinal cord injury (SCI). Typical causes of spinal cord damage are trauma, disease, or congenital disorders. Tetraplegia is a paralysis results in the partial or total loss of use of all limbs and torso; paraplegia is similar but does not affect the arms. Pain and spasticity are common sequelae of SCI [1]. Both pain and spasticity can have a late onset and develop slowly over time after SCI, and once developed, they often become chronic. In this paper we have provided to assess the effectiveness of acupuncture for treating SCI sequelae and summarize the potential mechanisms of acupuncture therapy. Method: We considered 30 patients with diagnosis of tetra or paraplegia after SCI complicated by neuropathic pain and spasticity. Neurologist trained in medical acupuncture conducted the therapeutic treatments. A specific set of acupuncture points was used in all sessions. Participants were treated for 8 sessions of acupuncture over 4 week’s period. Pain and spasticity were evaluated with Numeric Raiting Scale (VAS) (2) and the Modified Ashworth Scale [3] at the beginning of the first, the fourth an eighth treatment session. Results: 28 patients (93%) showed improvement in pain intensity and spasticity after two weeks of acupuncture treatment. The therapeutic effect continued until the eighth week of treatment. However, 15 patients (53,5%) reported an increase in spasticity and pain 2 months after acupuncture sessions. Conclusions: Acupuncture sessions using defined acupoint set reduced pain intentensity and spasticity in patients with SCI.
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