Yıl: 2019 Cilt: 29 Sayı: 2 Sayfa Aralığı: 196 - 200 Metin Dili: Türkçe İndeks Tarihi: 30-11-2021

Santral Ağrıda Nöromodülasyon

Öz:
Ağrı kendi içinde de nosiseptif ve nöropatik ağrı olarak ikiye ayrılır. Nosiseptif ağrı daha çok bası ile ya da hareketle uyarılan nosiseptörlerin etkisi ile ortaya çıkan kesici, bıçak saplanır tarzda ağrı olarak tarif edilir. Nöropatik ağrı ise doku hasarı sonrası ortaya çıkan yanıcı, batıcı tarzda ağrı olarak tanımlanır. Ağrının rahatlatılmasında ise medikal yöntemlerin yanı sıra, intratekal tedaviler ve sinir sisteminin elektriksel uyarımları yer almaktadır. Elektriksel uyarılarla tedavilerde periferik sinir uyarıları santral ağrıda yeteri kadar etkili olamamaktadır. Spinal kord stimülasyonu ile kısmen, talamus ya da motor korteks stimülasyonu ile daha etkin santral ağrı kontrolü sağlandığı yapılan çalışmalarda belirtilmiştir. Santral ağrının tedavisini üç ana başlık altına alırsak; bunlardan ilki antidepresan, antikonvülzan, analjezik ilaçlar gibi çeşitli farmakolojik yaklaşımlardır. Diğer bir tedavi yöntemi ise talamotomi, kordotomi ve DREZ lezyonu gibi ablatif ya da lezyon cerrahisi olarak adlandırdığımız girişimsel işlemlerdir. Üçüncü ve son başlık ise bu bölümde de genel hatları ile anlatacağımız nöromodülasyon yöntemleridir. Bunlar arasında transkutanöz elektriksel sinir uyarımı, spinal kord stimülasyonu, derin beyin stimülasyonu ve motor korteksin yüzeyel stimülasyonu gibi yöntemler mevcuttur. Santral nöropatik ağrıyı azaltmada en etkin nöromodülasyon yöntemleri olarak derin beyin stimülasyonu ve motor korteksin yüzeyel stimülasyonu söylenebilir.
Anahtar Kelime:

Neuromodulation in Central Pain

Öz:
Pain is divided into nociceptive and neuropathic pain. Nociceptive pain is defined as cutting, stabbing pain, which is caused by the action of nociceptors or by pressure. Neuropathic pain is defined as a the burning, shooting pain that occurs after tissue damage. In addition to medical methods, intrathecal therapies and electrical stimulation of the nervous system are used for pain relief. Peripheral nerve stimulation is not sufficiently effective for central pain. Studies have shown that spinal cord stimulation is less effective for central pain control than stimulation of the thalamus or motor cortex. Central pain therapy can be discussed in three sections. The first one includes the various pharmacological approaches such as antidepressant, anticonvulsant and analgesic drugs. Another treatment modality is the interventional procedures called ablative or lesion surgery, such as thalamotomy, cordotomy and DREZ lesion formation. The third and last section includes the neuromodulation methods, which will be explained here. These include transcutaneous electrical nerve stimulation, spinal cord stimulation, deep brain stimulation, and superficial stimulation of the motor cortex. Deep brain stimulation and superficial stimulation of the motor cortex can be said to be the most effective neuromodulation methods for reducing central neuropathic pain.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık
  • 1. Adams JE, Hosobuchi Y, Fields HL: Stimulation of internal capsule for relief of chronic pain. Journal of Neurosurgery 41:740-744, 1974
  • 2. Andersen G, Vestergaard K, Ingeman-Nielsen M, Jensen TS: Incidence of central post-stroke pain. Pain 61:187-193, 1995
  • 3. Arle JE, Shils JL: Motor cortex stimulation for pain and movement disorders. Neurotherapeutics 5:37-49, 2008
  • 4. Bittar RG, Kar-Purkayastha I, Owen SL, Bear RE, Green A, Wang S, Aziz TZ: Deep brain stimulation for pain relief: A meta-analysis. Journal of Clinical Neuroscience 12:515-519, 2005
  • 5. Boccard SG, Pereira EA, Moir L, Aziz TZ, Green AL: Longterm outcomes of deep brain stimulation for neuropathic pain. Neurosurgery 72:221-231, 2012
  • 6. Buschmann D, Oppel F: Periphere nervenstimulation. Der Schmerz 13:113-120, 1999
  • 7. Carroll D, Joint C, Maartens N, Shlugman D, Stein J, Aziz TZ: Motor cortex stimulation for chronic neuropathic pain: A preliminary study of 10 cases. PAIN® 84:431-437, 2000
  • 8. Chiou RJ, Chang CW, Kuo CC: Involvement of the periaqueductal gray in the effect of motor cortex stimulation. Brain Research 1500:28-35, 2013
  • 9. Devulder J, Crombez E, Mortier E: Central pain: An overview. Acta Neurologica Belgica 102:97-103, 2002
  • 10. Fontaine D, Hamani C, Lozano A: Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: Critical review of the literature. Journal of Neurosurgery 110:251-256, 2009
  • 11. Gybels J: Thalamic stimulations in neuropathic pain: 27 years later. Acta Neurologica Belgica 101:65-71, 2001
  • 12. Hirayama A, Saitoh Y, Kishima H, Shimokawa T, Oshino S, Hirata M, Kato A, Yoshimine T: Reduction of intractable deafferentation pain by navigation-guided repetitive transcranial magnetic stimulation of the primary motor cortex. Pain 122:22-27, 2006
  • 13. Hosobuchi Y, Adams JE, Rutkin B: Chronic thalamic stimulation for the control of facial anesthesia dolorosa. Archives of Neurology 29:158-161, 1973
  • 14. Jeanmonod D, Magnin M, Morel A: Low–threshold calcium spike bursts in the human thalamus: Common physiopathology for sensory, motor and limbic positive symptoms. Brain 119:363-375, 1996
  • 15. Khedr EM, Kotb H, Kamel N, Ahmed M, Sadek R, Rothwell J: Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain. Journal of Neurology, Neurosurgery & Psychiatry 76:833-838, 2005
  • 16. Kılınç M, Livanelioğlu A, Yıldırım SA, Tan E: Effects of transcutaneous electrical nerve stimulation in patients with peripheral and central neuropathic pain. Journal of Rehabilitation Medicine 46:454-460, 2014
  • 17. Kim J, Eun Lee S, Sik Min K, Jung HH, Lee JE, Kim SJ, Chang JW: Ventral posterolateral deep brain stimulation treatment for neuropathic pain shortens pain response after cold stimuli. Journal of Neuroscience Research 91:997-1004, 2013
  • 18. Klit H, Finnerup NB, Andersen G, Jensen TS: Central poststroke pain: A population-based study. PAIN® 152:818- 824, 2011
  • 19. Lefaucheur JP: Use of repetitive transcranial magnetic stimulation in pain relief. Expert Review of Neurotherapeutics 8:799-808, 2008
  • 20. Mallory GW, Abulseoud O, Hwang S-C, Gorman DA, Stead SM, Klassen BT, Sandroni P, Watson JC, Lee KH: The nucleus accumbens as a potential target for central poststroke pain. Mayo Clinic Proceedings 87:1025-1031, 2012
  • 21. Mazars G, Merienne L, Ciolocca C: Intermittent analgesic thalamic stimulation. Preliminary note. Revue Neurologique 128:273-279, 1973
  • 22. Melzack R, Wall PD: Pain mechanisms: A new theory. Science 150:971-979, 1965
  • 23. Monroe R, Heath R: Studies in schizophrenia: A multidisciplinary approach to mind brain relationships. Harvard University Press, 1954
  • 24. Monsalve GA: Motor cortex stimulation for facial chronic neuropathic pain: A review of the literature. Surgical Neurology International 3:S290, 2012
  • 25. Nguyen JP, Nizard J, Keravel Y, Lefaucheur JP: Invasive brain stimulation for the treatment of neuropathic pain. Nature Reviews Neurology 7:699, 2011
  • 26. Pagano RL, Fonoff ET, Dale CS, Ballester G, Teixeira MJ, Britto LR: Motor cortex stimulation inhibits thalamic sensory neurons and enhances activity of PAG neurons: Possible pathways for antinociception. PAIN® 153:2359-2369, 2012
  • 27. Pierre C, Mann MW, Moretti JL, Defer G, Roualdès B, Nguyen JP, Degos JD: Central pain and thalamic hyperactivity: A single photon emission computerized tomographic study. Pain 47:329-336, 1991
  • 28. Plow EB, Pascual-Leone A, Machado A: Brain stimulation in the treatment of chronic neuropathic and non-cancerous pain. Journal of Pain 13:411-424, 2012
  • 29. Pool J, Clark W, Hudson P, Lombardo M: Hypothalamichypophyseal interrelationships. Springfield, IL: Charles C Thomas, 1956
  • 30. Rokyta R, Fricová J: Neurostimulation methods in the treatment of chronic pain. Physiological Research 61:S23, 2012
  • 31. Schott G: From thalamic syndrome to central poststroke pain. Journal of Neurology, Neurosurgery, and Psychiatry 61:560, 1996
  • 32. Stadler JA, Ellens DJ, Rosenow JM: Deep brain stimulation and motor cortical stimulation for neuropathic pain. Current Pain and Headache Reports 15:8-13, 2011
  • 33. Stanton-Hicks M: Transcutaneous and peripheral nerve stimulation. Pain Research and Clinical Management 15:37- 56, 2003
  • 34. Sukul VV, Slavin KV: Deep brain and motor cortex stimulation. Current Pain and Headache Reports 18:427, 2014
  • 35. Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S: Chronic motor cortex stimulation in patients with thalamic pain. Journal of Neurosurgery 78:393-401, 1993
  • 36. Vartiainen N, Perchet C, Magnin M, Creac’h C, Convers P, Nighoghossian N, Mauguière F, Peyron R, Garcia-Larrea L: Thalamic pain: Anatomical and physiological indices of prediction. Brain 139:708-722, 2016
  • 37. Waldman SD: Pain review. Elsevier Health Sciences, 2016
APA DERE Ü, Kocabicak E (2019). Santral Ağrıda Nöromodülasyon. , 196 - 200.
Chicago DERE Ümit Akın,Kocabicak Ersoy Santral Ağrıda Nöromodülasyon. (2019): 196 - 200.
MLA DERE Ümit Akın,Kocabicak Ersoy Santral Ağrıda Nöromodülasyon. , 2019, ss.196 - 200.
AMA DERE Ü,Kocabicak E Santral Ağrıda Nöromodülasyon. . 2019; 196 - 200.
Vancouver DERE Ü,Kocabicak E Santral Ağrıda Nöromodülasyon. . 2019; 196 - 200.
IEEE DERE Ü,Kocabicak E "Santral Ağrıda Nöromodülasyon." , ss.196 - 200, 2019.
ISNAD DERE, Ümit Akın - Kocabicak, Ersoy. "Santral Ağrıda Nöromodülasyon". (2019), 196-200.
APA DERE Ü, Kocabicak E (2019). Santral Ağrıda Nöromodülasyon. Türk Nöroşirürji Dergsi, 29(2), 196 - 200.
Chicago DERE Ümit Akın,Kocabicak Ersoy Santral Ağrıda Nöromodülasyon. Türk Nöroşirürji Dergsi 29, no.2 (2019): 196 - 200.
MLA DERE Ümit Akın,Kocabicak Ersoy Santral Ağrıda Nöromodülasyon. Türk Nöroşirürji Dergsi, vol.29, no.2, 2019, ss.196 - 200.
AMA DERE Ü,Kocabicak E Santral Ağrıda Nöromodülasyon. Türk Nöroşirürji Dergsi. 2019; 29(2): 196 - 200.
Vancouver DERE Ü,Kocabicak E Santral Ağrıda Nöromodülasyon. Türk Nöroşirürji Dergsi. 2019; 29(2): 196 - 200.
IEEE DERE Ü,Kocabicak E "Santral Ağrıda Nöromodülasyon." Türk Nöroşirürji Dergsi, 29, ss.196 - 200, 2019.
ISNAD DERE, Ümit Akın - Kocabicak, Ersoy. "Santral Ağrıda Nöromodülasyon". Türk Nöroşirürji Dergsi 29/2 (2019), 196-200.