Bélanger Lise M A, Umedaly Hamed S, Noonan Vanessa K, Park So Eyun, Prince Jennifer, Thorogood Nancy P, Shen Tian, Townson Andrea F, Street John T, Dvorak Marcel F, Negraeff Michael
Acute Spine Program, Vancouver General Hospital.
Departments of Anesthesiology, Pharmacology and Therapeutics.
Clin J Pain. 2018 Feb;34(2):104-112. doi: 10.1097/AJP.0000000000000523.
A clinical protocol was developed for clinicians to routinely assess and initiate treatment for patients with neuropathic pain (NP) in an acute care setting. The objectives of this study were to: (1) determine the incidence and onset of NP in patients with traumatic spinal cord injury during acute care and (2) describe how the implementation of a clinical protocol impacts the assessment and diagnosis of NP.
The study was a cohort analysis with a pre-post-test utilizing a historical control. Data were retrospectively collected from a patient registry and charts. Participants were randomly selected in cohort 1 (control) and cohort 2 (NP clinical protocol).
The incidence of NP was 56% without significant difference between the cohorts (P=0.3). Onset of NP was 8 days (SD=14) across the study and >85% of the participants with NP were diagnosed within 2 weeks. Participants with incomplete injuries had a significant earlier onset than participants with complete injuries (6.2±12.8, 10.9±15.8 d; P=0.003). The mean number of days from hospital admission to initial assessment decreased with use of the NP clinical protocol (3.7±5.7 d; P=0.02).
This study demonstrates a high incidence and early onset of NP in traumatic spinal cord injury during acute hospital care, with an earlier emergence in participants with incomplete injury. The NP clinical protocol ensured continuous assessment and documentation of NP while decreasing the time to an initial screen, but did not impact diagnosis.
制定一项临床方案，供临床医生在急性护理环境中对神经性疼痛（NP）患者进行常规评估并启动治疗。本研究的目的是：（1）确定急性护理期间创伤性脊髓损伤患者中NP的发生率和发病时间，以及（2）描述临床方案的实施如何影响NP的评估和诊断。
本研究是一项采用历史对照的前后测试队列分析。数据从患者登记处和病历中回顾性收集。参与者在队列1（对照组）和队列2（NP临床方案组）中随机选取。
NP的发生率为56%，两组之间无显著差异（P=0.3）。整个研究中NP的发病时间为8天（标准差=14），超过85%的NP患者在2周内被诊断出来。不完全损伤的参与者比完全损伤的参与者发病时间显著更早（6.2±12.8天，10.9±15.8天；P=0.003）。使用NP临床方案后，从入院到初次评估的平均天数减少（3.7±5.7天；P=0.02）。
本研究表明，在急性医院护理期间，创伤性脊髓损伤患者中NP的发生率很高且发病早，不完全损伤的参与者发病更早。NP临床方案确保了对NP的持续评估和记录，同时缩短了初次筛查的时间，但未影响诊断。
