Management of Neuropathic Pain Associated with Spinal Cord Injury.
Management of Neuropathic Pain Associated with Spinal Cord Injury.
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DOI：
10.1007/s40122-015-0033-y
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发表时间：
2015-06
期刊：
影响因子：
4
通讯作者：
Rekand, Tiina
中科院分区：
文献类型：
--
作者：
Hagen, Ellen M;Rekand, Tiina
脊髓损伤(SCI)是一种脊髓损伤，导致不同程度的运动和/或感觉障碍和瘫痪。神经病理性和伤害性两种类型的慢性疼痛是常见的，并导致生活质量下降。综述的目的是提供当前的临床认识，以及讨论和评估在临床研究中所证明的药物干预的有效性。这篇综述是基于PubMed和Medline上的文献搜索得出的，检索词为“神经病理性疼痛”和“脊髓损伤”。综述包括临床研究，而不是实验数据或病例报告。关于脊髓损伤后神经病理性疼痛的治疗选择，确定了有限数量的随机和安慰剂对照研究。阿米替林是一种三环类抗抑郁药，抗癫痫药物加巴喷丁和普瑞巴林是研究最多的有效药物，被认为是首选。阿片类药物在临床研究中显示出相互矛盾的结果。此外，研究中使用的给药途径以及报道的副作用限制了阿片类药物以及氯胺酮和利多卡因的日常使用。局部应用辣椒素或利多卡因以及皮内注射肉毒毒素是一种新的治疗方式，到目前为止还没有在脊髓损伤人群中进行研究，需要进一步研究。非药物疗法可能对神经病理性疼痛有额外的影响。在疼痛治疗之前，应始终对疼痛类型进行彻底的临床评估。患者需要进行随访，以评估所应用措施的个体效果。然而，应用管理并不一定能达到满意的止痛效果。需要进一步的临床研究来评估现有的和新的治疗方案的效果。
Spinal cord injury (SCI) is an injury to the spinal cord that leads to varying degrees of motor and/or sensory deficits and paralysis. Chronic pain of both neuropathic and nociceptive type is common and contributes to reduced quality of life. The aim of the review is to provide current clinical understanding as well as discuss and evaluate efficacy of pharmacological interventions demonstrated in the clinical studies. The review was based on literature search in PubMed and Medline with words “neuropathic pain” and “spinal cord injury”. The review included clinical studies and not experimental data nor case reports. A limited number of randomized and placebo-controlled studies concerning treatment options of neuropathic pain after SCI were identified. Amitriptyline, a tricyclic antidepressant and the antiepileptic drugs, gabapentin and pregabalin, are most studied with demonstrated efficacy, and considered to be the primary choice. Opioids have demonstrated conflicting results in the clinical studies. In addition, administration route used in the studies as well as reported side effects restrict everyday use of opioids as well as ketamine and lidocaine. Topical applications of capsaicin or lidocaine as well as intradermal injections of Botulinum toxin are new treatment modalities that are so far not studied on SCI population and need further studies. Non-pharmacological approaches may have additional effect on neuropathic pain. Management of pain should always be preceded by thorough clinical assessment of the type of pain. Patients need a follow-up to evaluate individual effect of applied measures. However, the applied management does not necessarily achieve satisfactory pain reduction. Further clinical studies are needed to evaluate the effect of both established and novel management options.