Application of Spinal Pain Mapping in the Diagnosis of Low Back Pain-Analysis of 104 Cases

疼痛定位法於下背痛患者診斷與治療之應用－壹百零四個病例之分析

龐維伍(Wei-Wu Pang) ； 莫世湟(Martin S. Mok) ； 林木鍊(Mu-Lien Lin) ； 張大鵬(Da-Peng Chang) ； 黃明和(Min-Ho Hwang)

《Acta Anaesthesiologica Sinica》 36卷2期 (1998/06) Pp. 71-74

摘要

Background: Low back pain is probably the most common pain problem seen in a general pain clinic and the cause of low back pain can be enigmatic at times. Often the pain sources are difficult to identify with the conventional diagnostic modalities. Spinal pain mapping is a sequence of well organized nerve block procedures. We undertook this study to evaluate the usefulness of this modality in diagnosing low back pain of uncertain etiology. Methods: In this prospective study, 104 consecutive adult patients who underwent spinal pain mapping were examined and analyzed. All patients had intractable low back pain of undetermined etiology after medical history, physical examination and 4-view roentgenographic evaluation of the lumbar spine had been undertaken to locate it. In addition, 41 patients (39%) had one or more of the following tests done, which included CT, MRI, EMG/NC but all failed to delineate the causes of the pain. All patients failed to respond to the conservative therapies. Results: With pain mapping the source of pain was found to be caused by sacro-iliac joint in 6%, lumbar nerve root in 20%, facet joint in 24%, combined lumbar nerve root and facet disease in 24%, internal disc disorder in 7%, combined facet and sacro-iliac joint in 4% and lumbar sympathetic dystrophy in 2% of patients. Pain mapping failed to demonstrate the causes of the pain in the remaining 13% of the patients. Conclusions: Considering the difficult nature of this group of patients, spinal pain mapping provided a useful functional approach to the diagnosis of low back pain with obscure etiology in 87% of patients in our series.

關鍵字

Low back pain ； Mapping ； Nerve block

並列摘要

背景：本院及台北市立中興醫院等於去年開始使用精確疼痛定位術式，對104位病因不明背痛病患做了診斷暨治療，並做分析整理。我們已介紹過其原理、作法及其優缺點。我們在此報告分析整理之結果。方法：於一年時間內我們收集了合乎下列條件之下背痛病患：1）有3個月以上之病史，2）無心理病狀，3）無官能性下背疾病，4）病史，體檢，下背X-光已完成，5）保守性治療無效。共有104個病例，其中41（39%）位病患又經過CT，MRI，或EMG/NC等之檢查，其背痛之原因人依然不確定。我們應用了精確疼痛定位術式做了下一步之診斷。我們再對此104個病例做整理與分析。結果：在這104位病患使用了疼痛定位法後，我們發現有6%的病人疼痛由sacro-iliac joint引起，20%病人由lumbar nerve root引起，24%病人由facet joint引起，24%病人有lumbar nerve root和facet聯合病痛，7%病人有internal disc disorder，4%病人有facet和sacro-iliac joint聯合病痛，2%病人有lumbar sympathetic dystrophy之病痛，13%之病人疼痛定位法對他們無幫助。結論：精確疼痛定位術式為安全，簡單及合理的術式。在螢光鏡下以小於2西西的局部麻醉劑找出下背的疼痛組織以使複雜下背疼痛有了進一步之的診斷，對其治療，亦有好處。因此，這種術式有推廣應用與進一步研究的必要。

並列關鍵字

下背痛 ； 背痛定位 ； 神經阻斷術