The regulation of blood pressure is closely linked to sympathetic activity. This retrospective study analyzed 142 hypertensive patients undergoing computed tomography (CT)-guided O2-O3 neurolysis targeting intervertebral foramina or lumbar paravertebral ganglia for pain management. Results demonstrated significant reductions in both postoperative in-hospital blood pressure and office blood pressure during follow-up alongside decreased antihypertensive medication use. Notably, blood pressure reduction showed independence from pain relief but exhibited strong anatomical correlation with renal sympathetic innervation, specifically with the lower thoracic vertebral level (T9-T12) and the upper lumbar vertebral level (L1-L2). The findings suggest that modulation of thoracolumbar sympathetic pathways through minimally invasive gas neurolysis may represent a novel therapeutic strategy for hypertension management, potentially offering a targeted approach for renal sympathetic denervation. Further prospective studies are warranted to validate these observations.

Accumulating evidence from clinical trials in recent years has consistently supported the blood pressure (BP)-lowering efficacy of renal sympathetic denervation (RDN). However, the most widely used catheter-based RDN technique still has limitations in clinical practice. Therefore, it is necessary to develop an alternative RDN approach for BP control. In our previous clinical trial, we demonstrated that CT-guided ozone-mediated RDN effectively reduced both office and ambulatory BP at 12 weeks post procedure in patients with resistant hypertension (RH). In this study, we further evaluated the efficacy of this technique in home BP control of 15 patients with RH. Based on the reduced use of anti-hypertension drugs following the procedure, the control rates of home BP (<140/90 mmHg) for the overall cohort were 60.0%/93.3%, 80.0%/100%, and 80.0%/100% at weeks 4, 8, 12, respectively, and 57.1%/90.91, 81.8%/100% and 90.9%/100% at weeks 4, 8, 12 for patients with normal baseline renal function. Additionally, 33.3% patients achieved the optimal morning BP target of ≤135/85 mmHg. No complications were reported intra- or post procedure. We present a simplified, unilaterally operated, contrast-free RDN technique that avoids renal artery injury in the management of RH.

The sympathetic ganglion was the initial target of renal denervation (RDN) for treating resistant hypertension (RH). In this pilot Phase II single-arm, open-label clinical trial, we developed a modified neurolysis technique based on one of the traditional pain-relieving techniques, CT-guided ozone-mediated neurolysis, to treat RH. A total of 45 patients were enrolled and underwent the operation, which involved the injection of an oxygen-ozone gas mixture around the lumbar/renal ganglia under CT guidance. Following the procedure, the antihypertensive medication burden (AHMB) decreased from 4.2 pre-procedure to 3.5 at 3 months and 3.2 at 6 months post-procedure. Additionally, at 3 months post-procedure follow-up, there was a significant decrease in the average 24-h mean systolic blood pressure (SBP) by –6.8 ± 2.1 mmHg, morning SBP/diastolic blood pressure (DBP) by –9.2 ± 2.3/–4.7 ± 1.3 mmHg, and daytime SBP/DBP by –8.0 ± 2.4/–2.9 ± 1.5 mmHg. By 6 months post-procedure follow-up, compared with pre-operation values, we observed a significant decrease in the average 24-h SBP by –5.53 ± 0.76 mmHg, morning SBP by –5.6 ± 2.1 mmHg, and daytime SBP/DBP by –7.2 ± 0.96/–2.3 ± 0.6 mmHg. We did not find significant reductions in the 24-h mean DBP, morning DBP, and nighttime SBP/DBP at the 6-month follow-up. No adverse events were observed during or after the procedure. We concluded that CT-guided ozone-mediated neurolysis targeting the renal-related lumbar ganglia is a promising alternative for treating RH, with advantages including being minimally invasive, contrast-free, non-invasive to the renal artery, and cost-effective.

BACKGROUND:Renal sympathetic denervation (RDN) reduces blood pressure (BP). METHODS:This single-arm open-label study enrolled patients with resistant hypertension (RH) and treat them by CT-guided ozone mediated lumbar-renal sympathetic denervation (L-RDN). The primary endpoint was to assess the changes of BP over 24-h ambulatory BP monitoring (ABPM) and to evaluate the anti-hypertensive medication burden (AHMB) at 3-month follow-up. This study was registered in Chictr.org.cn (ChiCTR2300071375). RESULTS:17 patients (mean age 65.12 ± 10.77 years) with AHMB of 4.12 ± 1.11 were enrolled. After the procedure, 7 patients (46.7 %) matched the criteria for antihypertensive medication reduction. The AHMB decreased to 3.87 ± 0.96 for the whole objectives and from 3.87 ± 0.96 to 3.55 ± 0.78 for patients with normal baseline renal function. On top of the lessened AHMB, L-RDN further reduced morning systolic BP (SBP) by -8.6 ± 4.0 mmHg (p = 0.034) and diastolic BP (DBP) by -4.6 ± 2.1 mmHg (p = 0.032) for all participants and morning SBP by -13.2 ± 3.6 mmHg (p < 0.001), morning DBP by -6.2 ± 2.4 mmHg (p = 0.011) and daytime SBP by -4.1 ± 1.6 mmHg (p = 0.009) for those with normal baseline renal function at 3-month of follow-up. No adverse events were reported intra- and post operation. CONCLUSIONS:CT-guided ozone-mediated L-RDN might be an innovative approach of RDN for treating RH. Confirmatory studies are warranted.

长期以来,神经病理性疼痛(简称神经痛)的挑战一直使我着魔.1986年底以来我一直致力于带状疱疹后神经痛(postherpetic neuralgia,PHN)的临床诊疗和研究,除了喜欢极致的挑战外,得益于1982年我的导师曹子恩教授在研究生入学时的一句话:"如果一位医师能集中几十年实践于某种难治病,并且作出点贡献是非常困难和了不起的".

Thinking about the paper of radiofrequency ablation of cervical spinal nerve root under the guidance of CT for the treatment of patients with intractable cervical and occipital postherpetic neuralgia published in Chinese Journal of Painology June 2020, Vol.16, No.3, pages 214 to 219.

带状疱疹后神经痛 (postherpetic neuralgia,PHN) 是带状疱疹最严重的并发症,属于神经病理性疼痛范畴,水痘-带状疱疹病毒在某种原因侵袭人体后潜伏在神经节内,当人体免疫力低下的时候病毒沿着同阶段周围神经快速复制破坏神经并侵袭相应皮节,部分病人在皮损消退后,疼痛不缓解,称之为带状疱疹后神经痛 [1].通常表现为持续性烧灼痛、电击痛、刀割样痛等,同时可伴有感觉异常及迟钝,出现蚁行感、瘙痒,严重者还可伴有相应运动神经功能障碍.美国多项回顾性研究中,PHN发病率占带状疱疹病人6.5％～18％;前瞻性研究中,发病率更是高达 30％ [2].PHN发病率与年龄成增长趋势,且主要见于年龄>50岁人群,同时与风湿免疫疾病等慢性疾病有密切关系 [3].

At the begining of 2011, with our team's efforts, the 1st album of postherpetic neuralgia (PHN) treatment was issued after establishment of department of pain medicine in China and we are glad to see some highlights of standardizing diagnosis, treatment and translational study of intractable PHN for recent 10 years in China. PHN is still a intractable pain disease worldwide at present. The PHN patients should be told that it's a chronic disease needed to deal with a long time as hypertention and diabete. We will give some review of comments from NeuPSIG of IASP, mature standardizing diagnosis, treatment and translational study plan of intractable PHN, in clinic or clinical research, to our colleagues nationalwide, especially on the sympathetic therapy for intractable PHN.

硬膜外自控镇痛治疗 (patient controlled epidural analgesia, PCEA)是疼痛科常用的治疗方法,适用于颈腰腿痛、带状疱疹后神经痛等疾病 [1,2].但是,除了治疗效用外,PCEA也带来一些不良反应及并发症,合理的防治、细致的观察及护理尤其重要 [3].然而,目前关于PCEA治疗慢性疼痛疾病过程中护理观察的文献报道甚少,大样本的报道更罕见.本研究收集我院近两年336例接受皮下隧道式硬膜外自控镇痛治疗病人的临床资料进行回顾性分析,现报道如下.

八、神经病理性疼痛的临床治疗 神经病理性疼痛(neuropathic pain,NP)属于难治性疼痛疾病,现代的诊疗概念是:此症和高血压、糖尿病一样需要长期,甚至终身治疗.由于起效缓慢,患者需要付出耐心,且有合理的期望值.NP治疗的内涵包括:神经功能紊乱的调整治疗、消除神经源性炎症、解除神经根粘连、促进神经损伤修复治疗、预防或降低复发率.

BACKGROUND:In a 5-year follow-up study in a hospital in southern China, it was shown that intervertebral foramen (IVF) injection of ozone at the involved segmental levels could significantly alleviate paroxysmal spontaneous pain and mechanical allodynia in patients with chronic, intractable postherpetic neuralgia (PHN) and improve the quality of life. However, so far no proof-of-concept studies in animals have been available.OBJECTIVE:This study was designed to investigate whether IVF ozone has an analgesic effect on animal models of neuropathic and inflammatory pain.STUDY DESIGN:Experimental trial in rats.SETTING:Institute for Biomedical Sciences of Pain.METHODS:By IVF injection, a volume of 50 µl containing 30 µg/mL ozone-oxygen mixture or 50 µl air was carried out on male Sprague-Dawley rats of naïve, inflammatory pain states produced by injections of either bee venom or complete Freud's adjuvant, and neuropathic pain state produced by spared nerve injury, respectively. The effects of IVF ozone on pain-related behaviors were evaluated for 2 weeks or one month. Then combined use of gabapentin (100 mg/1 kg body weight) with IVF ozone was evaluated in rats with neuropathic pain by intraperitoneal administration 5 days after the ozone treatment. Finally, the analgesic effects of another 4 drugs, AMD3100 (a CXCR4 antagonist), A-803467 (a selective Nav1.8 blocker), rapamycin (the mTOR inhibitor), and MGCD0103 (a selective histone deacetylase inhibitor) were evaluated for long term through IVF injection, respectively.RESULTS:(1) IVF injection of ozone at L4-5 was only effective in suppression of mechanical allodynia in rats with neuropathic pain but not with inflammatory pain; (2) the analgesic effects of IVF ozone lasted much longer (> 14 days) than other selective molecular target drugs (< 48 hours) inhibiting or antagonizing at Nav1.8 (A-803467), CXCR4 (AMD3100), mTOR (rapamycin), and histone deacetylase (MGCD0103); (3) combined use of systemic gabapentin and IVF ozone produced a synergistic analgesic effect in rats with neuropathic pain.LIMITATIONS:Evaluation of the possible analgesic effects of the intraplantar injection of ozone was not performed.CONCLUSIONS:In the present study, we provided a line of evidence for the first time that IVF injection of ozone selectively relieved neuropathic pain but not inflammatory pain, and enhanced the analgesic effect of gabapentin.KEY WORDS:Chronic pain, neuropathic pain, inflammatory pain, ozone therapy, interventional therapy, gabapentin, spared nerve injury, bee venom, complete Freud's adjuvant.

目的:本文报道使用以臭氧介入为主的规范化诊疗综合方案用于顽固性、激惹型疱疹后神经痛患者的5年随访结果.方法:统计资料完整的顽固性躯干部疱疹后神经痛30例住院患者,病史4个月～4年,患者最多住院达10次.入院后接受以臭氧介入为主的规范化诊疗方案,即口服药物+病人自控硬膜外镇痛+臭氧介入治疗,采用自身对照方法考察治疗前、后抑郁量表、疼痛程度、红外线热图、患区遗留症状和睡眠质量等指标.随访评估五年.使用Poisson列联系数法进行统计资料处理.结果:年龄60～85岁(平均70.3±5.9岁).患区剧烈疼痛住院72小时内即得到有效控制,治疗前平均视觉模拟评分(visual analogue scale,VAS)评分为6.7±1.8分,抑郁评分(hamilton depression score,HAMD)评分为22.6±4.2分,局部温度为36.4±2.6℃.治疗后平均VAS评分为3.1±0.8分,HAMD评分为13.5±3.1分,局部温度差为3.6±0.6℃.本组患者未出现与治疗方案相关的并发症.结论:CT监护下以臭氧介入为主的规范化治疗可快速控制剧烈疼痛,使原发和继发损伤区消失或明显缩小,局部温度趋于正常,在长达5年左右随访期间效果比较稳定,疼痛程度及VAS评分未出现明显波动,患者情绪好转,绝大部分患者生活质量明显改善.

Objective To survey the current clinical practice of chronic non-cancer pain (CNCP)management including opioid use in Chinese subgroup report of Current Practices of Cancer and Chronic Non-Cancer Pain Management:A Pan-Asian Study (ACHEON).Methods This questionnaire-based survey included 100 pain physicians and 250 patients experiencing CNCP in the period of September to December in 2013.Results CNCP management training was believed by 40％ of physicians,while 30％ reported adequate pain-relief training on opioid use.Opioids were not considered as the best choice for CNCP management by 65％ of physicians.The majority of location of pain with CNCP was legs/feet (59.2％) and neck (39.2％),arthritis (37.22％),overuse (26.91％),and poor posture (35.56％) were reported as the primary causes of pain.A portion (81.6％) of patients was under treatment,while 66.67％ of patients claimed to be satisfied with their current pain treatment.74.51％ of patients reported that CNCP management was effective pain-relief.Conclusions The Chinese physicians were insufficient cognition of CNCP management on opioid use.The CNCP education and cognition strengthening,CNCP management practice and patient's satisfaction are still necessary for Chinese physicians and patients.

Postherpetic neuralgia(PHN)is still a typical intractable neuropathic pain disease worldwide at present.There are some clinical progresses for diagnosis and treatment for PHN in China recent 10years.Under suggestion and organization by Dr.Yu Shengyuan,the chairman of CASP,Dr.Wang Jiashuang,the convener of Chinese multidisciplinary expert group,worked together with experts from five disciplines to finish "Chinese consensus for the diagnosis and treatment of PHN" after one year' s hard working.This is the first individual neuropathic pain disease consensus and multidisciplinary consensus as well in China.The consensus is a new marker and step for the developing department of pain medicine in Chinese hospital.The consensus includes some specialized techniques used for diagnosis and treatment for PHN in Chinese hospital:fMR,thermography,PRF,SGB,ozone(O3) intervention therapy and adriamycin injection.

目的:三叉神经带状疱疹后神经痛是头面部疼痛疾病中最为剧烈的疼痛疾病之一.本文报道使用牛痘疫苗接种家兔炎症皮肤提取物(神经妥乐平)及连续星状神经节注药(CSGB)对比药物治疗三叉神经区疱疹后遗神经痛的临床疗效分析.方法:本组40例患者,病程3个月～4年.使用VAS评分评价疼痛程度;使用改良HAMD评价抑郁程度;同时检查治疗前、后损伤区域红外热图.门诊(OP)组治疗方法:甲钴胺2 mg/日,神经妥乐平2～4片/日,加巴喷丁600～900mg/日或普瑞巴林150～450mg/日.住院(IP)组治疗方法:口服药同OP组,CSGB处方:0.1％罗哌卡因200 ml+神经妥乐平6ml,连接PCA泵(ZBB-Ⅰ型,南通产),持续量0.5～1 ml/h,追加剂量0.5 ml/次,持续使用一周.两组患者均于治疗两周及随访一年后评价效果.结果:患者主诉头面部自发性闪电样疼痛、刀割样疼痛、烧灼样疼痛为主.两组患者平均HAMD评分为21.8±3.8分,平均VAS评分为7.8±1.6分.经过治疗后OP组和IP组患者平均VAS评分分别为5.4±1.2:3.2±0.8分,HAMD评分为18.5±3.1:11.2±2.1分;复发率为45％:20％;治疗前、后局部红外热图平均差值为:1.2～5.8℃.IP组经过14～18个月的随访,疗效相对稳定.对于复发患者则采用其他方法进行治疗.结论:两组头面疱疹后神经痛患者初步结果表明:与OP组治疗结果比较,IP组加用CSGB方法安全,有效,能够快速控制剧烈疼痛,患区后遗症状大部分缓解.经过一年左右随访大部分患者效果稳定,生活质量明显改善.

随着我国临床疼痛科的建设和发展,如何构建疼痛医学的科学知识体系已经成为大家面临的一个迫在眉睫的问题.另外,如何把疼痛基础研究的现状和发展趋势介绍给临床医师也是基础研究工作者的重要任务.本文旨在抛砖引玉,系统地介绍慢性痛发生的外周和脊髓中枢敏化机制.此外,虽然我们对慢性痛及其精神共病(如焦虑、失眠、抑郁等)的脑机制了解甚少,但本文对可能涉及的脑网络基础也做了简要介绍.希望本文能够引起临床同行的共鸣,推动基础与临床研究的合作与发展.

Intractable central post-stroke pain (CPSP) is one of the most common sequelae of stroke, but has been inadequately studied to date. In this study, we first determined the relationship between the lesion site and changes in mechanical or thermal pain sensitivity in a rat CPSP model with experimental thalamic hemorrhage produced by unilateral intra-thalamic collagenase IV (ITC) injection. Then, we evaluated the efficacy of gabapentin (GBP), an anticonvulsant that binds the voltage-gated Ca2+ channel α2δ and a commonly used anti-neuropathic pain medication. Histological case-by-case analysis showed that only lesions confined to the medial lemniscus and the ventroposterior lateral/medial nuclei of the thalamus and/or the posterior thalamic nucleus resulted in bilateral mechanical pain hypersensitivity. All of the animals displaying CPSP also had impaired motor coordination, while control rats with intra-thalamic saline developed no central pain or motor deficits. GBP had a dose-related anti-allodynic effect after a single administration (1, 10, or 100 mg/kg) on day 7 post-ITC, with significant effects lasting at least 5 h for the higher doses. However, repeated treatment, once a day for two weeks, resulted in complete loss of effectiveness (drug tolerance) at 10 mg/kg, while effectiveness remained at 100 mg/kg, although the time period of efficacious analgesia was reduced. In addition, GBP did not change the basal pain sensitivity and the motor impairment caused by the ITC lesion, suggesting selective action of GBP on the somatosensory system.

47岁的王司机患了椎间盘突出,在大型三甲医院骨科手术后,依然常常感觉疼痛,骨科医生建议他到康复科或疼痛科进行一些辅助治疗.他表示很疑惑,一个病居然要看三个科室? 不同专科,解决问题不一样 椎间盘突出,可到骨科、康复科、疼痛科就诊.实际上,各个学科所解决的问题是不一样的,比如:骨科,以手术纠正错位、特别严重的椎间盘突出为主;康复科主要解决软组织,以骨科手术后的功能康复为主;如果经常性发作,经过治疗改善一点,过段时间又出现,这种反复发作的情况,可能要到疼痛科进行治疗.还有一些患者,术后特别敏感,感觉疼痛,也是疼痛科解决的范围.