Kwan Vivian, Vo Mai, Noel Melanie, Yeates Keith
University of Calgary, Calgary, Alberta, Canada.
University of Alberta, Edmonton, Alberta, Canada.
J Neurotrauma. 2018 Apr 1;35(7):877-888. doi: 10.1089/neu.2017.5281. Epub 2018 Feb 9.
Headache is a common source of pain in children after traumatic brain injury (TBI); however, relatively little is known about nonheadache pain in this pediatric population. The present review seeks to map the extant literature to determine the prevalence, characteristics, and impact of nonheadache pain in children post-TBI of all severities. We found that of 109 studies published on pain in children after a TBI, 95 (87%) were focused exclusively on headache pain and only 14 (13%) reported on nonheadache pain or overall pain, with half ( = 7) in the form of case studies. Overall, the level of evidence was low, with only three level 1 high-quality prospective studies. In one study, over half (57.1%) of adolescents who experienced persistent pain post-TBI reported pain in body sites (e.g., back, lower limb, and neck). For each additional noncephalic pain site, the risk for developing chronic migraine is also increased. Nevertheless, pain in body regions other than the head is often not assessed systematically in pediatric TBI research. Findings of the current review suggest that pain assessment in children post-TBI needs improvement, given that pain is linked to worse recovery, poorer quality of life, and can be long-lasting. More rigorous examination of nonheadache pain and its role in impeding recovery in children post-TBI is imperative and has the potential to improve the care and management of children with TBI. We conclude with recommendations for pain assessment, discuss gaps in the literature, and highlight directions for future research.
头痛是儿童创伤性脑损伤(TBI)后常见的疼痛来源;然而,对于这一儿科人群中的非头痛性疼痛,我们了解得相对较少。本综述旨在梳理现有文献,以确定所有严重程度的TBI后儿童非头痛性疼痛的患病率、特征及影响。我们发现,在已发表的109项关于TBI后儿童疼痛的研究中,95项(87%)仅聚焦于头痛性疼痛,只有14项(13%)报告了非头痛性疼痛或总体疼痛,其中一半(即7项)为病例研究形式。总体而言,证据水平较低,仅有三项一级高质量前瞻性研究。在一项研究中,超过一半(57.1%)经历TBI后持续疼痛的青少年报告身体部位(如背部、下肢和颈部)疼痛。每增加一个非头部疼痛部位,发生慢性偏头痛的风险也会增加。然而,在儿科TBI研究中,头部以外身体区域的疼痛往往未得到系统评估。本次综述的结果表明,鉴于疼痛与更差的恢复情况、更低的生活质量相关且可能持续很长时间,TBI后儿童的疼痛评估需要改进。对非头痛性疼痛及其在阻碍TBI后儿童恢复中所起作用进行更严格的研究势在必行,这有可能改善TBI患儿的护理和管理。最后我们给出了疼痛评估的建议,讨论了文献中的空白,并突出了未来研究的方向。