PDF(Pubmed)
Abstract：
Neuropathic pain (NP), resulting from damage to the somatosensory system, is characterized by either spontaneous or evoked pain. In the context of NP, wherein aberrant signaling pathways contribute to the perception of pain, the thalamus emerges as a key player. This structure is integral to the pain network that includes connections to the dorsal horn of the spinal cord, highlighting its role in the affective-motivational aspects of pain perception. Given its significant involvement, the thalamus is targeted in advanced treatments such as thalamotomy and deep brain stimulation (DBS) when traditional therapies fail, emphasizing the need to understand its function in NP to improve management strategies. This review aimed to provide an overview of the role of the thalamus in the transmission of nociceptive information in NP by discussing the existing evidence, including the effectiveness and safety of current techniques in the management and treatment of NP. This is an integrative review involving the qualitative analysis of scientific articles published in PubMed/MEDLINE, Embase, Scopus, and Web of Science. A total of 687 articles were identified, and after selection, 15 articles were included in this study. All studies reviewed demonstrated varying degrees of effectiveness of DBS and thalamotomy in alleviating painful symptoms, although the relief was often temporary. Many studies noted a reduction in pain perception at the conclusion of treatment compared to pre-treatment levels, with this decrease maintained throughout patient follow-ups. However, adverse events associated with these treatments were also reported. In conclusion, there are some benefits, albeit temporary, to using thalamotomy and DBS to alleviate the painful symptoms of NP. Both procedures are considered advanced forms of surgical intervention that aim to modulate pain pathways in the brain, providing significant relief for patients suffering from chronic pain resistant to conventional treatment. Despite limitations, these surgical interventions offer renewed hope for patients facing disabling chronic pain and can provide a significant improvement in quality of life.
摘要：
神经性疼痛（NP），由于体感系统受损，表现为自发或诱发的疼痛。在NP的背景下，其中异常的信号通路有助于疼痛的感知，丘脑作为一个关键的球员出现。这种结构是疼痛网络的组成部分，包括与脊髓背角的连接，强调其在疼痛感知的情感动机方面的作用。鉴于其重大参与，当传统疗法失败时，丘脑是先进的治疗方法，如丘脑切开术和深部脑刺激（DBS）的目标，强调需要了解其在NP中的功能，以改进管理策略。这篇综述旨在通过讨论现有证据来概述丘脑在NP中伤害性信息传递中的作用。包括当前技术在NP管理和治疗中的有效性和安全性。这是一篇综合评论，涉及对PubMed/MEDLINE上发表的科学文章的定性分析，Embase,Scopus,和WebofScience。共鉴定出687篇文章,在选择之后，本研究包括15篇文章。回顾的所有研究都证明了DBS和丘脑切开术在减轻疼痛症状方面的不同程度的有效性。虽然救济往往是暂时的。许多研究指出，与治疗前的水平相比，治疗结束时的疼痛感知降低，在整个患者随访期间，这种下降保持不变。然而,还报告了与这些治疗相关的不良事件.总之,有一些好处，虽然是暂时的，使用丘脑切开术和DBS缓解NP的疼痛症状。这两种手术都被认为是旨在调节大脑疼痛通路的高级手术干预形式。为患有对常规治疗有抵抗力的慢性疼痛的患者提供了显着的缓解。尽管有局限性,这些手术干预措施为面临致残性慢性疼痛的患者提供了新的希望,并可显著改善生活质量.
