Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Pain Res Manag. 2011 May-Jun;16(3):159-68. doi: 10.1155/2011/518710.
Chronic pain clinics have been created because of the increasing recognition of chronic pain as a very common, debilitating condition that requires specialized care. Neuropathic pain (NeP) is a multifaceted, specialized form of chronic pain that often requires input from multiple disciplines for assessment and management.
To determine the impact of an interdisciplinary clinic for evaluation and treatment of patients with NeP.
Patients with heterogeneous etiologies for NeP were prospectively evaluated using an interdisciplinary approach every six months. Diagnostic evaluation, comorbidity evaluation, education, and pharmacological and⁄or nonpharmacological management were completed. Severity (visual analogue scale) and features of pain (Modified Brief Pain Inventory), sleep difficulties (Medical Outcomes Study - Sleep Scale), mood⁄anxiety disruption (Hospital Anxiety and Depression Scale), quality of life (European Quality-of-Life Five-Domain index), health care resources use, patient satisfaction (Pain Treatment Satisfaction Scale and Neuropathic Pain Symptom Inventory) and self-perceived change in well-being (Patient Global Impression of Change scale) were examined at each visit.
Pain severity only decreased after one year of follow-up, while anxiety and quality- of-life indexes improved after six months. Moderate improvements of sleep disturbance, less frequent medication use and reduced health care resource use were observed during enrollment at the NeP clinic.
Despite the limitations of performing a real-world, uncontrolled study, patients with NeP benefit from enrollment in a small interdisciplinary clinic. Education and a complete diagnostic evaluation are hypothesized to lead to improvements in anxiety and, subsequently, pain severity. Questions remain regarding the long-term maintenance of these improvements and the optimal structure of specialized pain clinics.
慢性疼痛诊所的创建是因为人们越来越认识到慢性疼痛是一种非常常见且使人虚弱的疾病，需要专门的护理。神经病理性疼痛（NeP）是一种多方面的、专门的慢性疼痛形式，通常需要多个学科的参与来进行评估和管理。
确定评估和治疗神经病理性疼痛患者的跨学科诊所的影响。
使用跨学科方法，每六个月对具有不同病因的 NeP 患者进行前瞻性评估。进行诊断评估、合并症评估、教育以及药物和/或非药物管理。评估严重程度（视觉模拟量表）和疼痛特征（改良简要疼痛量表）、睡眠困难（医疗结局研究-睡眠量表）、情绪/焦虑障碍（医院焦虑和抑郁量表）、生活质量（欧洲生活质量五维度指数）、卫生保健资源使用、患者满意度（疼痛治疗满意度量表和神经病理性疼痛症状量表）以及自我感知的幸福感变化（患者整体变化印象量表）。
只有在随访一年后，疼痛严重程度才会降低，而焦虑和生活质量指数在六个月后才会改善。在神经病理性疼痛诊所就诊期间，睡眠障碍、药物使用频率较低和卫生保健资源使用减少等方面都有中度改善。
尽管进行真实世界、无对照研究存在局限性，但 NeP 患者从参加小型跨学科诊所中获益。教育和全面的诊断评估被假设可以改善焦虑，进而改善疼痛严重程度。关于这些改善的长期维持以及专门疼痛诊所的最佳结构仍存在疑问。
