Rekand Tiina, Hagen Ellen Merete, Grønning Marit
Department of Neurology, Haukeland University Hospital, Norway.
Tidsskr Nor Laegeforen. 2012 Apr 30;132(8):974-9. doi: 10.4045/tidsskr.11.0794.
Chronic pain following spinal cord injury is common, and may result in a substantially reduced quality of life. The aim of the paper is to provide an overview of pain conditions resulting from spinal cord injuries and an update on therapy options.
The article is based on literature searches in PubMed review articles for the period 2006-2011, using the search phrases «pain and spinal cord injury/injuries», «chronic pain and spinal cord injury/injuries» and «neuropathic pain and spinal cord injury/injuries». Some key articles on neuropathic pain are also included, irrespective of the year of publication.
Patients with spinal cord injury may develop nociceptive and/or neuropathic pain.The cause, nature and localisation of the pain must be established before therapy is initiated. Neuropathic pain should primarily be treated with amitriptyline, gabapentin or pregabalin. Duloxetine, lamotrigine and tramadol may also be effective. Local treatment with high-concentration capsaicin and lidocaine may relieve localised neuropathic pain. Selected patients with intractable chronic neuropathic pain can be treated with intrathecal medication using an implanted pain pump or by microsurgical DREZotomy (Dorsal Root Entry Zone). Physiotherapy, non-steroidal anti-inflammatory drugs and opioids are most widely used for treating nociceptive pain. Physical exercise and acupuncture may provide relief from shoulder pain.
There may be several causes of chronic pain following spinal cord injury. Different measures have been tested for the management of chronic pain after spinal cord injury, but most studies have been performed on a limited number of patients. Further studies are needed to find more effective means of relieving pain following spinal cord injuries.
脊髓损伤后慢性疼痛很常见，可能会导致生活质量大幅下降。本文旨在概述脊髓损伤导致的疼痛状况，并更新治疗方案。
本文基于对2006年至2011年期间PubMed综述文章的文献检索，使用检索词“疼痛与脊髓损伤”、“慢性疼痛与脊髓损伤”以及“神经性疼痛与脊髓损伤”。还纳入了一些关于神经性疼痛的关键文章，无论其发表年份。
脊髓损伤患者可能会出现伤害感受性和/或神经性疼痛。在开始治疗前，必须明确疼痛的原因、性质和部位。神经性疼痛主要应使用阿米替林、加巴喷丁或普瑞巴林进行治疗。度洛西汀、拉莫三嗪和曲马多也可能有效。高浓度辣椒素和利多卡因局部治疗可缓解局部神经性疼痛。部分顽固性慢性神经性疼痛患者可使用植入式疼痛泵进行鞘内给药或通过显微手术进行背根入髓区切开术（DREZotomy）治疗。物理治疗、非甾体抗炎药和阿片类药物是治疗伤害感受性疼痛最常用的方法。体育锻炼和针灸可能有助于缓解肩部疼痛。
脊髓损伤后慢性疼痛可能有多种原因。针对脊髓损伤后慢性疼痛的管理已进行了多种措施的测试，但大多数研究的患者数量有限。需要进一步研究以找到更有效的缓解脊髓损伤后疼痛的方法。
