Frisbie J H, Aguilera E J
Spinal Cord Injury Service, Veterans Administration Medical Center, Brockton, MA 02401.
Paraplegia. 1990 Sep;28(7):460-5. doi: 10.1038/sc.1990.62.
The reliability of distinguishing central, musculoskeletal, and syringomyelic pain by two points of history: (1) pain quality and (2) pain location relative to the level of paralysis in spinal cord injury patients was tested by (1) physical examination, and (2) by radiographic imaging. Fifty five incidents of chronic pain (median duration 10 years, range 3 weeks-42 years) were found in a survey of 66 spinal cord injured patients. Central pain was suggested in 24 patients on the basis of a predominant 'neurogenic' pain quality: burning, stabbing, needles and pins, or numbness; and a location at or distal to the level of paralysis. Neurogenic pain was not associated with structural pathology in these patients. Musculoskeletal pain was suggested in 20 instances on the basis of predominantly aching pain and a location at or distal to the level of paralysis. Aching pain was associated with degenerative joint disease (11 each); scoliosis, shoulder dislocation, contractures (2 each); fracture, soft tissue calcium deposit (1 each) in 19 patients. Syringomyelic pain was suggested in 11 instances solely on the basis of pain location above the level of paralysis. Magnetic resonance imaging revealed extensive syringomyelia in 8 patients. It is proposed that the quality and location of chronic pain can quickly suggest confirmatory examinations, sometimes revealing correctable causes.
通过病史的两个要点鉴别脊髓损伤患者中枢性、肌肉骨骼性和脊髓空洞症性疼痛的可靠性：（1）疼痛性质和（2）相对于瘫痪平面的疼痛部位，通过（1）体格检查和（2）影像学检查进行测试。在对66例脊髓损伤患者的调查中发现了55例慢性疼痛事件（中位持续时间10年，范围3周 - 42年）。基于主要的“神经源性”疼痛性质：灼痛、刺痛、针扎样痛或麻木；以及在瘫痪平面或其远端的部位，24例患者被提示有中枢性疼痛。这些患者的神经源性疼痛与结构病理学无关。基于主要为酸痛且在瘫痪平面或其远端的部位，20例患者被提示有肌肉骨骼性疼痛。19例患者中，酸痛与退行性关节病（各11例）、脊柱侧凸、肩关节脱位、挛缩（各2例）、骨折、软组织钙沉积（各1例）有关。仅基于疼痛部位在瘫痪平面以上，11例患者被提示有脊髓空洞症性疼痛。磁共振成像显示8例患者有广泛的脊髓空洞症。有人提出，慢性疼痛的性质和部位可快速提示确诊检查，有时能揭示可纠正的病因。
