腰椎间盘的针刀治疗

,Part 13 Pain Therapy,Content,Introduction and Definition Classification The Basic Theropeutics Clinical Application of Local and Nerve Block,Chapter 1 Introduction and Definition,What is PainWhat is Analgesia,Pain as a warning signal,Gate Control Theory of Pain,Wall & Melzack, 1965Spinal gate in the dorsal horn of spinal cordPain neuromodulation,ChronicPain,CHRONIC PAIN,Who Should We Ask,To take care of these patientsPain Problem,Chronic Persistent Pain,No longer serves as a WarningButCauses Disability like other Chronic Disease,1950,Dr. John J Bonica,1953,Textbook “pain” By Bonica,1973,International Association for the Study of PainIASP,The Journal is devoted exclusively to subject, and lot of textbooks of pain is published.,Pain: Time for Re-Evaluation,The Debate,Pain as a warning signalVsPain as a chronic disease,World Congress on Pain,q. 3. year,The 9th World Congress was held in Vienna,1999The 10th World Congress was held in San Diego, 2002The 11th World Congress was held in Sydney,2005,Pain as the 5th vital sign,JACHO 2000T, HR, BP, RR, PainVital life functionsVariations indicate or reflect both physiological and psychological health,The 10th world congress on pain ( Sandiago 2002)suggested that pain should be the fifth major vital sign concurrently with blood pressure, pulse, heart rate and breathing.,Nociceptive sensitization of peripheral nervous system,persistent pain,Nociceptive sensitization of central nervous system,persistent pain,The imprint of pain in CNS,Chronic Pain is a Chronic Disease,Definition,Chapter 2 Classification,Chronic headacheNeuralgia and peripheral neuropathyAcute and chronic soft tissue damageRachiogenous painJoint painViceral painPainful peripheral vascular disordersMalignant pain,Nociceptive - consequence of tissue injuryMusculoskeletal, VisceralOpioid-responsivee.g., post-op pain, fractures, appendicitisNeuropathic - imprinted/aberrant activity of the PNS/CNSMost chronic pain is neuropathicOpioid-resistante.g., radiculopathy, CRPS (RSD), PHN,Types of Pain I: IASP,Nociceptive Pain (Somatic/Visceral),Results from mechanical, thermal, or chemical excitation of nociceptorsMediated at nociceptors widely distributed in skin, subcutaneous tissue, bone, muscle, connective tissue, vasculature, and visceraPain described as dull, aching, throbbing, sometimes sharpOpioid-responsive,Krames E. J Pain Symp Manage 1996;11(6):333-352.,Nerve ending initiatedServes initial protective function May resolve with healing of tissue damageOpioid-responsive,Nociceptive Pain,Neuropathic Pain,Results from actual damage to nerve or altered function of a nerveMay be mediated by N-Methyl-D-Aspartate receptorPain described as burning, tingling, shooting, electric-like, etc.May be opioid-resistant or require higher doses.,Krames E. J Pain Symp Manage 1996;11(6):333-352.Winkelmuller M, Winkelmuller W. J Neurosurg, 1996;85:458-467.,Neuropathic Pain,Imprinted pain of PNS and/or CNSLacks physiologic functionOpioid-resistantEssentially impossible to treat completelyGoal is to decrease pain while improving function,What dose the pain management specialist do?,Chapter 3 The Basic Therapeutics,Chronic Pain frequently cannot be eliminatedBut to be modulated and controlled,The goal of Pain Management,Pain Management and NOTPain Cure,Quality of Life,Minimize the pain & sufferingRestoration of Functions,Therapeutic methods,DrugLocal and nerve blockEpidural therapeuticsStellate gangline blockPituitary destructionEndocrainials injection of morphineStimulation,Therapeutic methods,PhysiotherapyBiofeedbackPsychotherapyMassageOperative therapyInjection of collagenase treat LDHDestruction of spinal nerve with the injection of alcohol or other destructive drugs,AnalgesicsPhysical therapyInterventional pain managementSurgeryChronic opioidsSpinal cord stimulation, pumpNeurolysis,Pain Treatment Ladder,Pharmacology of chronic pain,Interventional pain therapy,Interventional pain therapy,Nerve BlockChemoneurolysisCryoneurolysisThermoneurolysis (RF)Pulsed RF neuromodulationSpinal cord stimulatorPeripheral nerve stimulator,Deep Brain stimulatorIntraspinal drug delivery systemCatheter PumpBiopump (chromaffin cell implant)Gene Therapy,Radiofrequency Lesioning,Low Back with Lumbar Disc Disease,For low back pain,Laminectomy And Discectomy,Epidural Steroid Injection,Chemonucleolysis,Spine-Cath,IDET,Arthrocare System,DeKompressor,Minimally invasive therapy for LBP,Intradiscal ChemonucleolysisChymopapainCollegenase Percutaneous endoscopic discectomyAPLD (automatic percutaneous laser discectomy)Radiofrequency thermocoagulation nucleoplastyCoblation nucleoplastyDeKompressor nucleoplasty,For Compression Fracture of Spine,Failed Back (Surgery) Syndrome,Epidural AdhesionNerve Root AdhesionArachnoiditis,Epidurlysis,Spinal Cord Stimulator,Intraspinal Analgesia:Intrathecal or epidural administration of analgesic substance which produce profound and prolonged pain relief without sympathetic, sensory or motor block.,IMPLANTED DRUG DELIVERY SYSTEM,Implantation of adrenal medulla,The biological pump,Pain Therapy in the future,Gene Therapy,Minimally Invasive Interventional Pain Therapy,微創介入性疼痛治療,Interventional Radiology,AnesthesiaAnd Pain,Specialty is as follows:Anesthesiology 61%Neurology/ neurosurgery 11%Psychiatry/psychology 7%Physical