Saulino Michael, Averna Justin F
MossRehab, 60 Township Line Rd, Elkins Park, Philadelphia, PA, 19027, USA.
Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
Curr Pain Headache Rep. 2016 Sep;20(9):53. doi: 10.1007/s11916-016-0587-3.
Traumatic spinal cord injury (SCI) is a devastating neurological condition. Treatment of SCI-related pain is challenging for the treating physician, as normal neural pathways are disrupted. Patients with SCI consistently rate pain as one of the most difficult problems associated with their injury. SCI-related pain can be refractory and complete relief is often not possible. The multidimensional nature of SCI-related pain affects the neural system including autonomic nervous system deregulation and can alter metabolic and biochemical processes throughout the body. Co-morbid psychological illnesses such as depression and adjustment disorder are seen in a significant percentage of patients. Despite a better understanding of the underlying pain mechanisms and advances in procedural, pharmacologic, and non-pharmacologic therapies, treatment of pain after SCI remains elusive. This manuscript reviews the current evidence-based evaluation and management of the SCI patient with the overarching goal of providing appropriate and effective management of their pain. In particular, additional well-designed studies are needed to help elucidate effective treatments for SCI-related neuropathic pain in an effort to help provide these patients with better management of their pain and improve their quality of life.
创伤性脊髓损伤（SCI）是一种极具破坏性的神经系统疾病。对于治疗医生而言，治疗与SCI相关的疼痛颇具挑战，因为正常神经通路已被破坏。脊髓损伤患者一直将疼痛列为与损伤相关的最棘手问题之一。与SCI相关的疼痛可能难以治愈，常常无法实现完全缓解。与SCI相关的疼痛具有多维度特性，会影响神经系统，包括自主神经系统失调，并可改变全身的代谢和生化过程。相当一部分患者会出现诸如抑郁症和适应障碍等共病心理疾病。尽管对潜在疼痛机制有了更深入的了解，且在手术、药物和非药物治疗方面取得了进展，但SCI后疼痛的治疗仍然难以捉摸。本手稿综述了目前基于证据的对SCI患者的评估和管理，总体目标是为其疼痛提供恰当且有效的管理。特别是，需要更多精心设计的研究来帮助阐明针对与SCI相关的神经性疼痛的有效治疗方法，以便为这些患者提供更好的疼痛管理并改善他们的生活质量。
