| 摘要: | 星狀神經節阻斷術治療應用於自律神經失調、顏面疼痛、皰疹後神經痛、複雜性區域疼痛等病人已有數十年的歷史。傳統星狀節阻斷術是利用局部麻醉藥注射頸部神經節達到神經阻斷目的；然而，物理刺激也被認為是可能的治療方式。一些臨床證據說明，低能量雷射星狀神經節照射治療對於交感神經過度活躍症患者的疼痛改善有明顯治療效果。低能量雷射使用於醫療用途已有多年的歷史，此治療方式的優點為減少發炎反應、降低疼痛、促進組織癒合等。
我們設計了一交叉試驗(Crossover Trial)來比較此兩種方式對疼痛科病人的治療效果，本研究選定 21 名病患隨機分為二組分別接受為期一至二個月共十次星狀神經節阻斷術治療或低能量雷射星狀神經節照射治療，經過一週清除期(Washout period)後每組病患再交換接受另一種治療。我們蒐集病人在兩種治療療程前後之生命徵象、疼痛分數、憂鬱程度量表分數、生活品質分數等數據並且進行分析。
實驗結果顯示低能量雷射星狀神經節照射治療可明顯改善病人的疼痛程度以及降低疼痛造成之生活干擾，生理健康範疇方面總分有顯著改善。雷射及打針治療均可改善因疼痛造成之睡眠干擾，且在生活品質上均顯著改善。
由本研究結果得知低能量雷射星狀神經節照射治療可作為另一種治療選擇。低能量雷射星狀神經節照射治療有較低的副作用及較易操作等優點。因本研究尚有一些限制，進行與多數大型醫院合作為日後研究的方向。
Stellate ganglion block (SGB) therapy has been applied to patients with sympathetic disorders, such as facial pain, post-herpetic neuropathy (PHN) and complex regional pain syndrome (CRPS) for decades. Some series of evidence revealed that noninvasive stellate ganglion light irradiation (SG-LI) could also exert positive effects on pain and autonomic dysfunctions in patients with sympathetic hyperactivity disorders. Low-level laser therapy (LLLT) has been applied to medical treatment for years. Clinical application of low-level laser therapy can reduce regional healing time, inflammation and pain sensation.
We designed a randomized, cross-over trial to compare the treatment effect between low-level laser stellate ganglion stimulation and traditional stellate ganglion block with local anesthetic. In this study, twenty-one patients were randomly divided into two groups. Each group received SGB therapy and low-level laser stellate ganglion stimulation for 10 times, respectively. Between these two different therapy courses, there was a one-week washout period. Each group started their therapy course from SGB or low-level laser stellate ganglion stimulation and then switched to another therapy course after washout period. We compared the treatment effect of patient’s vital signs, heart rate variability (RRIV), brief pain inventory (BPI), Beck Depression Inventory-II (BDI-II) and WHO Quality of Life (WHOQOL-BREF) questionnaire score between two therapy courses.
Our results revealed that patients who received low-level laser stellate ganglion stimulation have significance improvement in levels of pain, life interference due to pain, general life quality and category of physiological health (p<0.05). Patients who received SGB have significant improvement on sleep quality, general life quality and lower cardiac output (p<0.05).
We concluded that low-level laser stellate ganglion stimulation can be an alternative treatment choice for patients visiting pain clinic with pain or sympathetic disorders. There are some advantages such as fewer adverse effects, easier to operate and more satisfaction for patients than traditional SGB. However, our results have some limitations in patient number, inclusion criteria, methodology, and statistic bias. Large in-depth studies are needed in the future. |
