神經痛治療的新利器--脈動式的射頻電磁波治療!! (腦神經外科 李昆興 主治醫師 / 洪純隆 教授 )王先生是一位六十八歲的商人，主訴脖子及左肩膀、左上手臂麻痛已三年多了，近日因惡化，到外院作復健牽引，不料症狀卻更加劇，如針刺，隱隱作痛，一觸摸到皮膚就誘發疼痛，根本無法活動，痛不欲生，已三天無法睡覺，苦不堪言！家人見狀不忍，將其送醫。經核磁共振掃描檢查，發現第五、六頸椎間有椎間盤突出，壓迫到神經造成頸椎神經根病變與神經痛。病患因個人因素，暫不考慮開刀，經充分討論後，在局部麻醉下，利用電腦斷層定位，作頸椎神經根的「脈動式的射頻電磁波(Pulsed radiofrequency)」治療，時間約半小時，治療後疼痛立即消失，王先生頓時整個人都輕鬆起來，活動自如，還神情自若地看報紙，當天晚上安穩一覺睡到天亮，隔天就愉快的辦理出院，目前仍門診追蹤。另一案例是一位五十八歲的林太太，因下背痛及右腳酸麻、疼痛，持續四個多月，在當地花蓮多方求治檢查，也到大型教學醫院做腰椎核磁共振掃描，並沒有發現有椎間盤突出或神經根壓迫的情形，後來轉診到本院神經外科，再經詳細的神經學檢查後，診斷是化學性腰神經根發炎，同樣採用上述的方法，作腰椎神經根的「脈動式的射頻電磁波」治療，治療後疼痛由原本痛苦指數從很嚴重的十分減輕至一分，當住院醫師的林太太的兒子，也注意到了母親露出了久未見過的笑容，還一直向我們醫護人員感恩道謝，隔天林太太就自行走路，愉悅地辦理出院，回到花蓮老家，目前門診追蹤中。頸部酸痛與腰酸背痛是門診常常遇到的問題，也是現代人的文明病。它的成因很多，也很複雜。真正的病因，還是須要醫師詳細的理學與神經學檢查、影像學的檢查等等，找出原因，再來做進一步正確地處置。因此對於經其他保守療法治療效果不彰的神經痛案例，目前可用「脈動式的射頻電磁波」來治療，以減輕病人的疼痛。這是一種低侵犯性，安全性相對高的治療方式。其作用機轉是：以改變神經細胞膜與細胞內分子電位差的變化，而對神經細胞的功能發生影響，進一步對疼痛治療產生其療效。傳統的射頻電磁波是持續的，不斷地釋放週期電波；而「脈動式的射頻電磁波」是間斷的，它在每秒內有二次20msec週期電磁波釋放，其餘時間是沒有電磁波釋放的，而其最高溫度設定於攝氏四十二度，以間斷式的方式作用來產生電磁範圍，選擇性地作用於無髓鞘的神經C纖維，而不會破壞神經產生病理性的變化。一般而言，溫度超過攝氏四十五度，在幾分鐘內，神經細胞便會死亡，而在攝氏四十二度至攝氏四十四度之間，神經細胞仍是可逆性的變化，此時可讓神經細胞受到驚嚇(stunning)，並改變其神經功能，藉以調整疼痛的感覺。
Pulsed Radiofrequency Treatment HOW IS THE TREATMENT PERFORMED? The patient is positioned on a padded x-ray table. Painful areas are marked and observed under x-ray if necessary. The skin over the injection site is thoroughly cleaned and t hen numbed using a local anaesthetic. An electrode (a fine needle) is then inserted through the numbed skin near the nerve which may be involved in pain transmission. Some procedures will be done under x-ray guidance. The nerve is located by gentle stimulation and the patient may feel a tingling sensation, heavines s or warmth in the area where the pain is located. Then the pulsed radio frequency electrical field is applied intermittently, (which you may or may not feel). Immediately after the treatment the majority of patients feel an improvement or relief in their pain, but in some patients the relief may take a few week s to take effect. Some patients may not feel any relief at all.
Radiofrequency Ablation for Arthritis Pain Radiofrequency ablation (or RFA) is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.
Which Conditions Are Treated With Radiofrequency Ablation? RFA can be used to help patients with chronic (long-lasting) low-back and neck pain and pain related to the degeneration of joints from arthritis.
How Long Does Pain Relief From Radiofrequency Ablation Last? The degree of pain relief varies, depending on the cause and location of the pain. Pain relief from RFA can last from six to 12 months and in some cases, relief can last for years. More than 70% of patients treated with RFA experience pain relief.
Is Radiofrequency Ablation Safe? RFA has proven to be a safe and effective way to treat some forms of pain. It also is generally well-tolerated, with very few associated complications. There is a slight risk of infection and bleeding at the insertion site. Your doctor can advise you about your particular risk.
What Are the Side Effects of Radiofrequency Ablation? The main side effect of RFA is some discomfort, including swelling and bruising at the site of the treatment, but this generally goes away after a few days.
Who Should Not Get Radiofrequency Ablation? As with any medical procedure, RFA is not appropriate for everyone. For example, radiofrequency ablation is not recommended for people who have active infections or bleeding problems. Your doctor can tell you if you should not have RFA.
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