Song Kwang-Sup, Cho Jae Hwan, Hong Jae-Young, Lee Jae Hyup, Kang Hyun, Ham Dae-Woong, Ryu Hyun-Jun
Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Asian Spine J. 2017 Aug;11(4):661-674. doi: 10.4184/asj.2017.11.4.661. Epub 2017 Aug 7.
Systematic literature review. To review the evidence from high-quality studies regarding the treatment of neuropathic pain originating specifically from spinal disorders. In general, treatment guidelines for neuropathic pain cover all its various causes, including medical disease, peripheral neuropathy, and cancer. However, the natural history of neuropathic pain originating from spinal disorders may differ from that of the pain originating from other causes or lesions. An expert research librarian used terms related to neuropathic pain and spinal disorders, disc herniation, stenosis, and spinal cord injury to search in MEDLINE, Embase, and Cochrane CENTRAL for primary research from January 2000 to October 2015. Among 2,313 potential studies of interest, 25 randomized controlled trials (RCTs) and 21 systematic reviews (SRs) were included in the analysis. The selection was decided based on the agreement of two orthopedic surgeons. There was a lack of evidence about medication for radiculopathy arising from disc herniation and stenosis, but intervention procedures, including epidural block, showed positive efficacy in radiculopathy and also limited efficacy in spinal stenosis. There was some evidence based on the short-term follow-up regarding surgery being superior to conservative treatments for radiculopathy and stenosis. There was limited evidence regarding the efficacy of pharmacological and electric or magnetic stimulation therapies for neuropathic pain after spinal cord injury. This review of RCTs and SRs with high-quality evidence found some evidence regarding the efficacy of various treatment modalities for neuropathic pain related specifically to spinal disorders. However, there is a need for much more supportive evidence.
系统文献综述。旨在回顾高质量研究中关于专门源自脊柱疾病的神经性疼痛治疗的证据。一般来说，神经性疼痛的治疗指南涵盖了其所有各种病因，包括内科疾病、周围神经病变和癌症。然而，源自脊柱疾病的神经性疼痛的自然病史可能与源自其他病因或病变的疼痛不同。一位专业研究馆员使用与神经性疼痛和脊柱疾病、椎间盘突出、狭窄以及脊髓损伤相关的术语，在MEDLINE、Embase和Cochrane CENTRAL中检索2000年1月至2015年10月的原始研究。在2313项潜在的感兴趣研究中，分析纳入了25项随机对照试验（RCT）和21项系统评价（SR）。选择是由两位骨科医生共同决定的。对于因椎间盘突出和狭窄引起的神经根病，缺乏药物治疗的证据，但包括硬膜外阻滞在内的干预措施在神经根病中显示出积极疗效，在腰椎管狭窄症中疗效有限。基于短期随访有一些证据表明，手术治疗神经根病和狭窄优于保守治疗。关于脊髓损伤后神经性疼痛的药物治疗以及电刺激或磁刺激疗法的疗效，证据有限。这项对具有高质量证据的随机对照试验和系统评价的综述发现了一些关于各种治疗方式对专门与脊柱疾病相关的神经性疼痛疗效的证据。然而，仍需要更多的支持性证据。
