神経障害性疼痛に対するDual–lead を用いた脊髄刺激療法とlow–dose ketamine 点滴療法の併用効果

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Objective. Based on the results of a drug-challenge test with ketamine, we applied low-dose ketamine drip infusion (LDKI) therapy combined with dual-lead spinal cord stimulation therapy (Dual-SCS) for the treatment of various kinds of neuropathic pain. We report about benefits of this combined therapy. Methods. In the drug-challenge test with ketamine, 5 mg of ketamine hydrochloride (i.v.) was given every 5 min up to 25 mg. Ketamine hydrochloride (0.33 mg/kg) added to 100 ml of saline was administered intravenously by 1-hour drip infusion every 2 weeks for LDKI therapy. Combined with this LDKI therapy, Dual-lead SCS therapy was applied for the treatment of various kinds of neuropathic pain. Results. Comparing with single-lead SCS, Dual-lead SCS had obvious advantages to evoke paresthesia restricted only over the painful area. LDKI therapy directly and markedly reduced the intractable pain from 1 hour to 3 days, and also increased the effects of Dual-lead SCS for CRPS, failed-back syndrome, post-stroke pain, and phantom limb pain. Conclusion. Dual-lead SCS combined with LDKI therapy is useful for the treatment of various kinds of neuropathic pain. Even if the direct effect of ketamine is transient, effects that provide release from central sensitization and the wind-up phenomenon may be important to increase the effects of Dual-lead SCS.
日本疼痛学会の論文