神经电刺激治疗慢性头面部疼痛：综述（二十五）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Antony AB,  Mazzola AJ,  Dhaliwal GS, et al. Neurostimulation for the Treatment of Chronic Head and Facial Pain: A Literature Review[J]. Pain Physician, 2019, 22(5):447-477. 本次学习由陈阳住院医师主讲。

For SCS, novel technologies are currently being tested to best therapeutically stimulate the active targets. For instance, closed-loop systems have the ability to automatically adjust stimulation levels to maximize the overall time the patient receives the optimal therapeutic dose. These advances have the capabilities to be adapted to treat head and facial pain. With innovative technology and an expanding knowledge base, the future for neuromodulation remains promising.

对于SCS，目前正在测试新技术，以最佳地治疗刺激靶点。例如，闭环系统具有自动调节刺激水平以使患者接受最佳治疗剂量的总时间最大化。这些进步有可能用于治疗头面痛。随着技术创新和知识库扩展，神经调节的未来仍然充满希望。

Conclusions

The nerves of the head and face form an elaborate and often interconnected network. A stimulus affecting one nerve has the ability to cause responses of nearby structures and may mimic symptomatology from other regions. Common first-line therapy primarily consists of oral medications. As many patients continue to progress to chronic states of pain, surely the current treatments are lacking. Historically, interventions such as nerve blocks and surgery served a role in this intractable population. Lately, the field of neuromodulation has become instrumental in this vulnerable subset of treatment failure patients. Neuromodulation has the opportunity to have a longer duration of relief than injections and often has a lower risk profile compared with other surgical procedures, partly owing to the reversibility of the stimulator implantation.

结论

头面部神经形成一个复杂且经常相互连接的网络。刺激一条神经能够引起附近结构的反应，并可能诱发其他区域的症状。常见的一线治疗主要是口服药物。由于许多患者继续发展为慢性疼痛状态，因此当前的治疗方法是欠缺的。从历史上看，神经阻滞和手术等干预措施在这一顽固人群中起着重要作用。最近，神经调节领域已成为药物失败患者这一脆弱群体的重要工具。与其他外科手术相比，神经调节有机会比注射获得更长的缓解时间，并且通常具有较低的风险，部分原因是刺激器植入的可逆性。

Many patients live with facial pain that is refractory to conservative treatment. As discussed earlier, multiple pathologies have shown positive results with PNS of various targets. For neuromodulation to be effective, the patient must be correctly diagnosed and selectively chosen so that targeted nerve stimulation can allow for a successful outcome. Larger, randomized, controlled trials are required before many of these treatments can be defined as standard of care and evidenced-based medicine. The future of craniofacial nerve stimulation is promising as advances in our overall collective knowledge, as well as in hardware and surgical technique, allow for better outcomes.

许多患者面部疼痛保守治疗无效。如前所述，多种疾病对各种靶点的PNS均显示出积极的结果。为了使神经调节有效，必须正确诊断并有选择地筛选患者，以便有针对性的神经刺激取得成功的结果。需要进行大型的随机对照试验以将其作为治疗标准或循证基础的治疗。颅面神经刺激的未来是有希望的，因为我们的整体认识以及设备和外科技术的进步将带来更好的结果。

Much of the advances in neuromodulation for the head and face will stem from perfecting the techniques previously described and devising ideal treatment plans including optimizing patient selection. Some of the strongest evidence for implantable neuromodulation in facial pain includes ONS for both migraine and occipital neuralgia, and SPG microstimulation for CH (Table 3). Regarding noninvasive neuromodulation, there is positive evidence for tVNS for both migraines and CHs, as well as combined transcutaneous supraorbital plus supratrochlear nerve stimulation for migraines (Table 3).

头面部神经调节的许多进步将来自完善先前描述的技术和制定理想的治疗计划，包括优化患者选择。面部疼痛中可植入神经调节的最有力证据包括偏头痛和枕部神经痛的ONS，以及CH的SPG微刺激（表3）。关于非侵入性神经调节，有偏头痛和CH的tVNS的有利证据，以及偏头痛的经皮眶上加滑车上神经联合刺激（表3）。