Hong Kong Pain review – Visceral pain and neuropathic pain

Visceral Pain

Visceral pain is caused by obstruction, infiltration or compression of visceral structures and supporting

connective tissues.3 Lung, liver and kidney parenchyma are insensitive to pain, but tumours associated with these organs may cause pain when the capsule or adjacent structures are affected.4 Visceral pain is often diffuse and sometimes referred to other nonvisceral structures, making the source of pain difficult to localize.

Neuropathic Pain

Studies indicate approximately 30% to 55% of cancer patients have neuropathic pain, which is due to involvement of neural structures (eg, nerves, plexi or roots), usually by tumour infiltration or compression. Sympathetic activity also plays a role in spontaneous neuropathic pain. This type of pain is characterized as aching, burning, stabbing or lancinating.3,4 It may also present as paraesthesia, dysaesthesia, hyperalgesia or allodynia. Relative to somatic and visceral pain, neuropathic pain responds poorly to systemic opioids, hence other treatments are often utilized. Most post-treatment pain syndromes (eg, postsurgical, postradiotherapy or postchemotherapy pain) are neuropathic.3 Injury to the intercostobrachial nerve during mastectomy causes a tight, burning sensation in the axilla, the medial aspect of the upper arm and the upper aspect of the anterior chest wall. Radiation-induced fibrosis can cause peripheral nerve injury. Vincristine, cisplatin and paclitaxel are neurotoxic and can cause dysaesthesia, paraesthesia, cramps and restless legs associated with weakness, sensory loss or autonomic dysfunction. This set of recommendations aims to provide a logical approach to

effectively manage cancer pain, with a particular focus on neuropathic pain. Patients may have several cancer pain syndromes that respond differently to pharmacological and nonpharmacological interventions. Therefore, a pain management programme should be devised on an individual basis depending upon patient characteristics and responses. Multiple medications may be used, with each agent adjusted according to the specific pain syndrome for which it is used.7 Pain management should be guided by a detailed patient assessment.

Reference source: http://www.neuroPAINhk.org, www.brain-spine.com.hk

The above information is for educations only, if you have any related disease, please consult your neurosurgeon for more information.

Prevalence, Pathophysiology and Symptoms of Neuropathic Cancer PAIN – Hong Kong review

PAIN can be a persistent and incapacitating symptom of cancer. Although reports indicate only 15% of patients with nonmetastatic disease experience tumour-associated PAIN at the time of diagnosis, PAIN becomes more pervasive as disease progresses.1 In patients with recurrent or metastatic cancer, 67% complain of PAIN and 41% experience PAIN directly attributable to the disease. PAIN may be

chronic or acute, and patients with chronic PAIN commonly experience acute flares of PAIN. One half to two thirds of patients with well-controlled chronic PAIN experience transitory ‘breakthrough’ PAIN. Cancer-associated PAIN may be secondary to antineoplastic therapy or an unrelated comorbid condition, but is commonly due to direct tumor involvement (ie, infiltration or compression of adjacent local structures, such as bone, soft tissue, nerves or the gastrointestinal tract).1,4 Hence, cancer PAIN syndromes can be somatic, visceral or neuropathic in origin.3 Understanding and recognizing these

syndromes can help identify PAIN etiology and the need for additional evaluation, and target therapy

more appropriately.

Reference source: http://www.neuroPAINhk.org, www.brain-spine.com.hk

The above information is for educations only, if you have any related disease, please consult your neurosurgeon for more information.

Migraine headache

Migraine headache is a common and often undertreated condition in the Asia-Pacific region.

Migraine is a recurrent, often debilitating headache disorder that causes significant impairment to the patient’s quality of life.1 The International Headache Society (IHS) has classified migraine into six subtypes2:

1.          migraine without aura

2.          migraine with aura

3.          childhood periodic syndromes that are

4.          commonly precursors of migraine

5.          retinal migraine

6.          complications of migraine

7.          probable migraine

Each of these subtypes is characterized by specific features and associated symptoms. These recommendations focus on the first two subtypes: migraine with and without aura. The

main difference between these two subtypes is the presence of focal neurological symptoms in

migraine with aura.2 These symptoms generally precede or accompany the headache.

The prevalence of migraine in females (12%–17%) is about twice that in males (6%–8%); while migraine attacks may commence at any age, the highest incidence is between 35 and 45 years.1,3-6 In some studies,

the lifetime prevalence in females has been estimated to be as high as 24%. Epidemiological studies have estimated the median frequency of migraine attacks to be 1–1.5 a month.1,3 A survey in Hong Kong in 1998 revealed that the estimated prevalence of migraine is 12.5%, similar to that reported in Western populations, with a greater preponderance in females. More patients have migraine without aura than migraine with

aura. Migraine sufferers often have lower health-related quality of life than non-migraineurs. The impact of

migraine extends beyond the patient’s personal life, affecting work, family and social activities.9 In the United States, costs attributed to migraine amount to US $13 million annually due to missed workdays and impaired work function. A number of clinical and community-based studies have demonstrated that patients with migraine are also likely to suffer from certain comorbid psychiatric disorders, such as depression, generalized anxiety.

Reference source: http://www.neuropainhk.org, www.brain-spine.com.hk

The above information is for educations only, if you have any related disease, plese consult your neurosurgeon for more information.

常見的頭痛種類有哪些？

約六成以上的人每個月會經歷至少一次頭痛，雖然沒有伴隨其他異狀，但卻不可忽略，這可能是一些嚴重疾病的表徵，像是腫瘤、血腫或腦膜炎就會因為在顱內敏感的組織中擴張或發炎而引發疼痛。你知道日常發生的頭痛種類有哪些嗎？

張力性頭痛

約所有頭痛者的90%，發生原因目前無法明確掌握，一般來說，患者會因為壓力增加而加重疼痛感，可能會有慢性壓抑、焦躁或者服用止痛藥過量的現象。張力性頭痛沒有明顯的前驅症狀、頭痛主要沿著兩側擴散。發作時間可能是每天或間歇性，也可能持續數小時到數天時間。

張力性頭痛的治療法

必須採取保守性的治療方法，以冷敷先降低壓力，同時採用規律的運動及放鬆治療法。如果是藥物治療，必須先判斷病症屬於偶發性還是慢性，可以採用不易上癮的止痛藥劑與肌肉鬆弛劑治療。而慢性、張力性頭痛比偶發性頭痛更難治療，可能還需要加上抗憂鬱劑甚至手術才行。

偏頭痛

約有6% 的頭痛是屬於偏頭，偏頭痛發病的原因目前無法完全掌握。一般說來，女性比較常出現偏頭痛的毛病，約多出男性3倍的機率，這可能跟女性荷爾蒙動情素有關，尤其是30歲左右的女性更容易有這類毛病。偏頭痛的特點是搏動性疼痛，而且常常伴隨著噁心及嘔吐症狀。每個月可能發作1-10次不等，每次發作時間可能持續4-24小時。

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的神經外科醫生查詢，而不應單倚賴以上提供的資料。

Spinal neuropathic pain conditions treated with minimally invasive spine surgery by neurosurgeron

If you have back pain and non-surgical treatments aren't working for you, then you may be a candidate for minimally invasive spine surgery.

Minimally invasive spine surgery is different from standard open spine surgery because it combines technology with innovative techniques so you can have smaller incisions, and a shorter hospital stay. In fact, minimally invasive spine surgery can often be performed on an outpatient basis.

Although minimally invasive spine surgery accomplishes what traditional open spine surgery accomplishes, it's an attractive option if you need spine surgery for a certain spine conditions because there are fewer risks involved than in open spine surgery.

Numerous spine conditions can be treated using minimally invasive spine surgery like degenerative disc disease, Herniated discs, Sciatica, Spinal stenosis, Scoliosis or other spinal deformities, Spondylolisthesis, Spinal fractures, Spinal infections Spinal tumors. 

It's important to note that not all spine conditions can be treated using minimally invasive surgery. In rare cases, if you have a certain spinal infection, sometimes it cannot be treated minimally invasively.

If minimally invasive spine surgery is an option for you, your neurosurgeon will explain the types of surgery he or she recommends. In most cases, minimally invasive spine surgery can effectively and safely treat your pain.

Because of rapid advances in technology, many spine disorders now can be treated with minimally invasive surgery, so talk to your doctor about any questions or concerns you have regarding MISS

Reference source: spineuniverse.com

The above information is for educations only, if you have any related disease, plese consult your neurosurgeon for more information.

神經外科醫生治療椎間盤突出 (Hong Kong neurosurgery, scoliosis)

很多人都有腰背痛，問題其中一個成因是椎間盤突出，長遠更可能形成骨刺，治療方法包括椎間盤切除手術但復發率較高，藍明權醫生指，新的微創手術可以解決這個問題. 

蔡太以前從事服裝批發經常要搬貨，背部近腰的位置七年前已開始痛，痛到不能再工作，在街市下車，我下不了車，痛到突然起身，痛得下不了車，那種痛苦痛到好像條腰不是自己.

蔡太是椎間盤突出，椎間盤是脊椎骨之間的軟組織，它像是一條中間充滿啫喱的車胎，車胎老化或意外撕裂，中間的啫喱就會流出，壓著神經線，這種情況通常出現於腰椎第四至五節之間，痛楚由這裡延伸至臀部，大小腿及腳掌，嚴重更可以引致肌肉萎縮，當影響到坐骨神經時，腳會麻木，可能甚至沒有感覺，有些嚴重的可能影響力度，開始行不到，有些持續很久，肌肉會萎縮，如果啫喱狀的椎間盤核心長時間或大量流失，脊椎骨之間失去緩衝，互相磨擦，最終形成骨刺.

神經外科藍明權醫生表示不少病人是搬重物時姿勢不正確，突發出硫椎間盤撕裂，但長時間坐著工作而坐姿不對，都會令椎間盤突出，如情況不嚴重可用推拿、物理治療等方法治療，但嚴重便要做手術. 傳統手術是將突出的椎間盤切除，但手術後有三至五成病人於半年至十年間復發，因椎間盤核心容易透過手術的傷口再次流出，新手術就是將啫喱完全抽出，放進一顆珠子，珠子代替原本椎間盤核心的功能，包括保持關節的活動保持骨與骨之間的距離及防避震. 但椎骨本身位置異常的人不適宜做這個手術.

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的神經外科醫生面對面查詢，而不應單倚賴以上提供的資料。

水刀治療椎間盤神經痛 (參考資料: www.brainspine.com.hk)

原來腰椎也可以做微創手術 ，痊癒後就不會有疤痕，慢著，腰椎有很多神經線做微創手術會否有危險做每個手術都有一定的風險，至於微創手術的過程，藍明權腦﹝神經﹞外科專科醫生，其中有三種類型。

水刀手術
水刀是一條這麼細的管道經過皮膚到椎間盤裡面在椎間盤裡面抽掉一部份突出的椎間盤，令椎間盤縮小一點就不會壓著神經線，這種方法適合膨漲型的椎間盤突出。適合較年青，膨漲型患者，年輕的病人，沒有骨刺的病人，但有些病人的椎間盤突出已經完全脫離­椎間盤可能不太適合用。

內視鏡
內視鏡直徑只有8毫米有些很細小的儀器. 內視鏡手術：適合椎間盤完全脫離之患者，可以穿過這個儀器將裡面突出的椎間盤清除當然­若年紀很大已經有骨刺，很硬的骨形成了而造成椎間盤突出，壓著神經線可能要用相對較大的手術儀器。

管道式微創手術
適合較年長，有骨刺之患者，大約16毫米用細小的儀器去做清除骨刺，突出的椎間盤手術會在無菌的手術室在完全消毒的狀況下，進行手術過程也會有一個特別的X光來透視病人的身體，放入手術儀器時可直達椎間盤的傷口做完微創手術通常休息幾小時就可以開始活動最初一星期，建議別太操勞待肌肉等恢復之後可以回復正常活動坐骨神經痛，我們通常建議病人可以先接受物理治療或藥物治療，若經過一段時間譬如六星期也無法治­療的話，可能需要考慮手術的治療. 用什麼方法治療要因應每個病人的身體狀況來決定。

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的神經外科醫生面對面查詢，而不應單倚賴以上提供的資料。

What is neurosurgery? And what is the neurosurgeon do?

Neurosurgery is a specialty of surgery which provides the critical care, prevention, diagnosis, evaluation, treatment, and rehabilitation of neurological disorders. This includes the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify the function or activity of the nervous system, including the hypophysis and the operation and non-operative treatment of pain. As such, neurosurgery encompasses treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain, meninges, and the skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland, disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.

What is neurosurgeon?

Neurosurgeon is a surgical doctor specialized in neurological disorders.

Central Nervous System (CNS) disorders - Stroke, Parkinsonism disease, Dementia, Brain tumors, Acoustic neuroma, Arteriole-venous malformation (AVM), etc...

Peripheral Nervous System (PNS) disorders – like Back pain, Scoliosis, Sciatica, Low back pain, Neck pain, Neuropathic pain, etc…  .

Reference information: www.brain-spine.com.hk, http://www.surgery.cuhk.edu.hk/neuro/default.htm

The information above is used for educational purpose only, for any enquiries, please consult your neurosurgeon for medical advices.