PDF(Pubmed)
Abstract：
Both the diagnosis and treatment of pain are evolving, especially in interventional approaches. Diagnosis of low back pain combines old and new methodologies, in particular, it involves an expanded role for ultrasound. While low back pain is a common complaint, there are many etiologies to the condition which must be explored before a final diagnosis can be made and treatment planned. Tumors and infections are rarely involved in low back pain but should be ruled out in the initial phase itself since failing to address them early can have devastating consequences. Some invasive treatments seem promising in the management of low back pain. Treating musculoskeletal pain with regenerative medicine, such as platelet-rich plasma, holds great promise. Autologous blood products are safe and may help stimulate the body\'s own responses for regeneration. The so-called \"orthobiologics\" play a role in sports medicine and the treatment of musculoskeletal pain. Neuromodulation, especially spinal cord stimulation, is undergoing a renaissance with new waveforms, devices, and a greater albeit incomplete understanding of its mechanisms of action. Spinal cord stimulation is not a first-line therapy and not all patients or all back problems respond to this treatment. Nevertheless, the therapy can be safe, effective, and cost-effective with appropriate patient selection. Radiofrequency ablation of nerves in the form of neurotomy can be effective in reducing the pain of osteoarthritis. These procedures, including the newer cooled radiofrequency neurotomy, can restore function, reduce pain, and may potentially have an opioid-sparing effect. Technical expertise in nerve and anatomy is needed for the use of this technique. This review article aims to provide updated information on some invasive intervention techniques in pain management.
摘要：
疼痛的诊断和治疗都在不断发展，尤其是在介入方法中。下腰痛的诊断结合了新旧方法，特别是,它涉及超声波的扩展作用。虽然腰痛是常见的主诉，在做出最终诊断和计划治疗之前，必须探索该疾病的许多病因。肿瘤和感染很少涉及腰痛，但应该在初始阶段就排除，因为未能及早解决它们可能会造成毁灭性后果。一些侵入性治疗在治疗腰背痛方面似乎很有希望。用再生医学治疗肌肉骨骼疼痛，如富血小板血浆，有很大的希望。自体血液制品是安全的，可能有助于刺激身体自身的再生反应。所谓的“正生物学”在运动医学和肌肉骨骼疼痛的治疗中发挥作用。神经调节,尤其是脊髓刺激,正在经历新波形的复兴，设备,以及对其行动机制的更大尽管不完整的理解。脊髓刺激不是一线治疗，并不是所有患者或所有背部问题都对这种治疗有反应。然而，治疗是安全的,有效,和成本效益与适当的病人选择。神经切开术形式的神经射频消融可有效减轻骨关节炎的疼痛。这些程序,包括较新的冷却射频神经切断术，可以恢复功能，减轻疼痛,并可能具有阿片类药物保护作用。使用这种技术需要神经和解剖学方面的技术专长。本文旨在提供有关疼痛管理中一些侵入性干预技术的最新信息。
