脈衝射頻治療於神經病變性疼痛電生理學探討及長期植入之行為研究

Abstract

依據文獻指出脊柱相關的慢性背痛，於一生中的盛行率高達60~80 %，每年美國治療背痛所耗費的醫療成本約為1000億美金，除了影響病患生活品質、也降低個人社會生產力；目前臨床於疼痛控制上，以止痛藥物治療為主、物理及心理治療為輔，而其藥物副作用較大且有其限制，近十年來新興的治療選擇 ─ 脈衝射頻電刺激治療，低風險且疼痛緩解效果佳，雖然機轉至今仍有待釐清，但也讓受疼痛所苦的病患重新燃起一線希望。 因此本研究透過模擬臨床神經病變疼痛模式，將電極或電刺激器整體長期植入，每周固定給予一次PRF電刺激治療5分鐘、刺激腰椎第5節的背根神經節、共持續4個療程達35天，以觀察接受脈衝射頻電刺激的長期疼痛抑制效果，結果顯示神經病變大鼠疼痛閾值提升；另外臨床上使用神經傳導速率進行神經病變與傳導的檢查，本研究也透過電生理進行神經傳導與阻斷的驗證，結果證明PRF電刺激影響神經疼痛的傳導、且具有疼痛緩解的效果。

According to literatures, the prevalence of spine-related back pain is up to 60~80% in human whole life. In America, the medical-cost of back pain treatment is around 100 billion USD annual. However, Back pain not only affects patients' life quality but reduce personal productivity. From now on, medical treatment is the primary choice to pain control, physical and psychological treatments are second opinions, but medical treatment has its side effects and limitations. Decades, the new alternative treatment - Pulse radiofrequency (PRF), has less risks and better effects to pain relief. Although PRF mechanism is still needs to be proven, but that give hopes to those suffered from pain. Thus, this research performs a clinical pain model to observe the long-term effect of pain relief with PRF. We stimulate the dorsal root ganglion (DRG) of lumbar of 5th (L5) with long-term implanted electrode or stimulator. The PRF procedures intervene 5 minutes per week, total 4 times PRF treatment course till 35 days. The result reveals the improvement of pain threshold in neuropathy rats. In the other hand, the nerve conduction velocity is usually used to examine the clinic patients of neuropathy and nerve conduction dysfunction. Therefore, we use electrophysiological (EPS) technique to validate the nerve modulation after PRF intervention. The outcome proves PRF affects the pain conduction and achieves pain relief.