LPE EA 4338, service de médecine physique et de réadaptation et centre stéphanois de la douleur, CHU de Saint-Etienne, hôpital Bellevue, 42055 Saint-Etienne cedex 1, France.
Ann Phys Rehabil Med. 2009 Mar;52(2):83-102. doi: 10.1016/j.rehab.2008.12.012. Epub 2009 Feb 23.
Chronic pain is very frequent after spinal cord injury, recent data showing that at least 80% of the patients experience pain, one-third at a severe level. The main objective of the present work is to report and discuss data regarding tools and procedures for the screening, diagnosis, and evaluation of neuropathic pain in spinal cord injury patients.
The method used is that developed by the SOFMER, which associated a systematic review of the literature and a selection of published works by a scientific commitee, an analysis of data performed by a binom neuropathic pain/physical medicine and rehabilitation (PM&R) specialists, an evaluation of current practices during an expert consensus conference and via Internet, and finally a validation of the whole work by a pluridisciplinary expert panel.
The literature provides an important series of studies on pain in spinal injury, but without specific data about neuropathic pain in this population. Some specific diagnostic and evaluation tools for neuropathic pain have been developed these last years, while numerous classifications, based on various criteria, have been proposed, some of them exhibiting some advantages for a pragmatic application and being in parallel in accordance with recent nosological and physiopathological advances.
The DN4 questionnaire can be used for the screening and identification of neuropathic pain in this population of patients, often suffering from various types of pain. The use of the Spinal Cord Injury Pain Task Force of the International Association of the Study of Pain classification (SCIP-IASP), although some limitations, is recommended since taking into account physiopathology, localisation, and nature of pain. Daily uses of Visual Analogic Scale (VAS) or Numeric Scale (NS) are an obvious need and that of the questionnaire Douleur de Saint-Antoine (QDSA) for global evaluation and more specifically of the Neuropathic Pain Symptom Inventory (NPSI) for neuropathic pain are highly recommended.
脊髓损伤后常发生慢性疼痛，最近的数据显示至少 80%的患者存在疼痛，其中三分之一为重度疼痛。本研究的主要目的是报告和讨论用于脊髓损伤患者神经病理性疼痛筛查、诊断和评估的工具和程序的数据。
采用 SOFMER 方法，该方法结合了文献系统评价和科学委员会选择的已发表作品，由神经病理性疼痛/物理医学与康复（PM&R）专家对数据进行分析，在专家共识会议上通过互联网评估当前实践，最后由多学科专家小组对整个工作进行验证。
文献中提供了大量关于脊髓损伤疼痛的研究，但没有关于该人群中神经病理性疼痛的具体数据。近年来，已经开发出一些用于神经病理性疼痛的特定诊断和评估工具，同时也提出了许多基于不同标准的分类，其中一些分类具有实用优势，并且与最近的分类学和病理生理学进展相平行。
DN4 问卷可用于筛查和识别该患者群体中的神经病理性疼痛，这些患者通常患有多种类型的疼痛。虽然存在一些局限性，但推荐使用国际疼痛研究协会脊髓损伤疼痛工作组的分类（SCIP-IASP），因为它考虑了病理生理学、定位和疼痛性质。建议日常使用视觉模拟评分（VAS）或数字评分（NS），并且强烈推荐使用 Saint-Antoine 疼痛问卷（QDSA）进行整体评估，特别是使用神经病理性疼痛症状量表（NPSI）进行神经病理性疼痛评估。
