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山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。 本次文献选自Antony AB, Mazzola AJ, Dhaliwal GS, et al. Neurostimulation for the Treatment of Chronic Head and Facial Pain: A Literature Review[J]. Pain Physician, 2019, 22(5):447-477. 本次学习由陈阳住院医师主讲。 Eagle’s Syndrome
Eagle’s syndrome is a condition with 2 subtypes causing orofacial pain. Usually after a tonsillectomy, “classic type” presents with a foreign body sensation in the throat, dysphagia, frequent swallowing, and pain referred to the ear and TMJ region. Dr. Eagle hypothesized that this was due to scar tissue compressing and stretching nerve structures around the styloid process. “Carotid type” Eagle’s syndrome occurs when an elongated styloid process impinges on the carotid artery. This can involve either the external carotid only or the internal carotid as well. Symptoms are usually exacerbated by turning the head toward the affected side. Some 4% to 7.3% of the general population are found to have an elongated styloid process and of this small cohort only 4% to 10.3% will present with pain. Eagle’s syndrome disproptionately affects women and the elderly. Several mechanisms have been proposed for the etiology of pain including pressure on surrounding structures, compression of adjacent nerves primarily the glossopharyngeal nerve, lower branch of the trigeminal nerve or chorda tympani, degenerative changes at the tendinous stylohyoid insertion, or irritation of the sympathetic nerves through impingement of the carotid vessels. Currently, Eagle’s syndrome is defined as unilateral headache that includes neck, pharyngeal, and/or facial pain that is the result of inflammation of the stylohyoid ligament. Because of the mechanical nature of injury, pain is often instigated by palpation of the stylohyoid ligament or by head turning. Usual treatments range from conservative management with systemic analgesics, to local steroid infiltration, and even surgical intervention. Although successful management of Eagle’s syndrome with PRF treatment has been reported, there remains little data to support management of this condition with neurostimulation. Styloidectomy is considered the treatment of choice. 伊格尔综合征
是一种具有2种亚型的疾病，可引起口面部疼痛。通常在扁桃体切除术之后，“经典型”会出现喉咙异物感、吞咽困难、频繁吞咽和涉及耳朵和TMJ区域的疼痛。Eagle博士假设这是由于瘢痕组织压迫和拉伸围绕茎突周围的神经组织所致。“颈动脉型” Eagle综合征发生在过长的茎突撞击到颈动脉时。这可能只涉及颈外动脉，也可能涉及颈内动脉。通常，将头转向患侧会加剧症状。总人群中约有4％至7.3％的人茎突过长，而在这些人中，只有4％至10.3％会出现疼痛。伊格尔综合征对妇女和老年人的影响更为严重。对于疼痛的病因已经提出了几种机制，包括周围结构的压力、对相邻神经的压迫（主要是舌咽神经、三叉神经的下支或鼓索）、颈突舌骨肌腱附着的退行性改变或通过撞击颈动脉对交感神经的刺激。目前，Eagle综合征被定义为由于舌骨韧带发炎而引起的包括颈部、咽部和/或面部在内的单侧疼痛。由于损伤的机制，通常通过按压颈突舌骨韧带或旋转头部来减轻疼痛。通常的治疗方法包括应用全身镇痛药的保守治疗、局部类固醇浸润甚至是手术干预。尽管已经报道了通过PRF治疗可成功治疗伊格尔综合征，但是几乎没有数据支持通过神经刺激治疗这种疾病。茎突切除术被认为是治疗的选择。 Paroxysmal Hemicrania
Paroxysmal hemicrania (PH) is a trigeminal autonomic cephalgia that is both underreported and underdiagnosed according to a recent review. Prevalence is suggested to be approximately 2 to 20 per 100,000. Age of onset is generally 30 to 40 years,affecting both men and women equally. Some 10% of cases display a clear trigger mechanism with the most common being neck movement. Only approximately 20% of PH behave episodically, and many of these ultimately end up developing into a chronic form in which attacks occur for > 1 year with remission periods of < 3 months in between. Patients commonly present with 5 to 40 attacks per day lasting 2 to 30 minutes each. It most commonly affects the temporal region in a unilateral fashion and is associated with typical cranial autonomic symptoms, such as lacrimation, conjunctival injection, or rhinorrhea. The occipital region may be involved in up to 40% of cases. Neck and shoulder pain may be present in up to one-third of cases. A distinguishing feature of PH is resolution of symptoms with indomethacin. However, a subset of patients has been identified in which symptoms are severe and do not respond to indomethacin or other pharmacologic interventions. One case report using a sphenopalatine endoscopic ganglion block with local anesthetic and steroid demonstrated significant frequency and pain relief in a patient who was unresponsive to conservative treatment . In these refractory cases, transcutaneous stimulation of the vagal nerve and neuromodulation of the GON or SPG may be an option. 阵发性偏头痛
阵发性偏头痛（PH）是一种三叉神经性自主性头痛，根据最近的一项综述，该病既未报告，也未明确诊断。患病率约为2-20/100，000。发病年龄一般为30至40岁，男女均等。大约10％的病例显有明确的触发机制，最常见的是颈部运动。只有大约20％的PH为发作性的，并且其中许多最终发展成一种慢性形式，其中发作期> 1年，缓解期＜3个月。患者通常每天出现5至40次发作，每次发作持续2至30分钟。它往往影响单侧颞部，并伴有典型的颅神经自主症状，例如流泪、结膜充血或流鼻涕。多达40％的病人可能影响枕骨区域。多达三分之一的病例可能出现颈部和肩部疼痛。PH的一个显着特征是吲哚美辛可以缓解症状。但是仍有一部分患者症状严重且对消炎痛或其他药物干预无反应。一项内镜下应用局部麻醉药和类固醇进行蝶颚神经节阻滞的病例报告显示，对保守治疗无反应的患者可显着降低频率并减轻疼痛。在这些难治性病例中，迷走神经的经皮刺激和枕大神经或蝶颚神经节的神经调节可能是一种选择。
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