The use of high-intensity focused ultrasound as a novel treatment for painful conditions-a description and narrative review of the literature
The use of high-intensity focused ultrasound as a novel treatment for painful conditions-a description and narrative review of the literature
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DOI：
10.1093/bja/aev302
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发表时间：
2015-10-01
影响因子：
9.8
通讯作者：
deSouza, N. M.
中科院分区：
文献类型：
--
作者：
Brown, M. R. D.;Farquhar-Smith, P.;deSouza, N. M.
高强度聚焦超声（HIFU）是一种非侵入性技术，它允许在组织目标内产生一个小的，边界良好的热损伤。组织破坏的发生是由于损伤内的直接加热和声空化的机械效应。HIFU已被广泛应用于临床，包括恶性肿瘤、子宫肌瘤和心律失常的治疗。最近，人们对使用这种技术治疗疼痛的兴趣有所增加。许多痛苦的条件已经成功地治疗，包括肌肉骨骼变性，骨转移和神经性疼痛。HIFU导致镇痛的确切机制尚不清楚，但它被认为是由于组织靶点的局部去神经支配和/或神经调节作用。尽管初步结果令人鼓舞，但大多数调查HIFU治疗疼痛的研究仍处于早期阶段。进一步的研究表明，以提高我们对这种治疗机制的理解，并充分确定其疗效；然而，HIFU很可能在未来的疼痛管理中发挥作用。这篇叙述性综述综合了最近与该主题相关的突出临床和基础科学研究，并对HIFU发挥其作用的机制进行了一般介绍。
High-intensity focused ultrasound (HIFU) is a non-invasive technique that allows a small, well-circumscribed thermal lesion to be generated within a tissue target. Tissue destruction occurs due to direct heating within the lesion and the mechanical effects of acoustic cavitation. HIFU has been used in a broad range of clinical applications, including the treatment of malignancies, uterine fibroids and cardiac arrhythmias. Interest in the use of the technique to treat pain has recently increased. A number of painful conditions have been successfully treated, including musculoskeletal degeneration, bone metastases and neuropathic pain. The exact mechanism by which HIFU results in analgesia remains poorly understood, but it is thought to be due to localised denervation of tissue targets and/or neuromodulatory effects. The majority of studies conducted investigating the use of HIFU in pain are still at an early stage, although initial results are encouraging. Further research is indicated to improve our understanding of the mechanisms underlying this treatment and to fully establish its efficacy; however, it is likely that HIFU will play a role in pain management in the future. This narrative review provides a synthesis of the recent, salient clinical and basic science research related to this topic and gives a general introduction to the mechanisms by which HIFU exerts its effects.