Li Liandong, Han Yawei, Li Tengshuai, Zhou Jiaming, Sun Chao, Xue Yuan
Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China,
Department of Histology and Embryology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China.
J Pain Res. 2018 Jun 25;11:1231-1238. doi: 10.2147/JPR.S160463. eCollection 2018.
Central cord syndrome (CCS) may be associated with severe neuropathic pain that often resists to conventional pain therapy regimens and affects the patients' quality of life (QoL) seriously. Current treatments for CCS-associated neuropathic pain have limited evidence of efficacy. This retrospective study was performed to present the effects of early treatment with methylprednisolone (MP) on acute neuropathic pain relief and the QoL in CCS patients.
Data were collected from the medical records of CCS patients who suffered from acute neuropathic pain with allodynia. All the patients received intravenous MP treatment for up to 1 week. Patients were evaluated with standard measures of efficacy: neuropathic pain intensity, the area of allodynia, and the QoL at baseline, daily treatment, and at 1 and 3 months after the end of MP treatment.
Thirty-four eligible patients were enrolled in our study. By the end of MP treatment, the proportion of patients who gained total or major (visual analog scale [VAS] score decreased by 50% or more) allodynia relief from the treatment was 91.18%, and a decrease in spontaneous pain was also observed. Moreover, this study showed MP could significantly improve the QoL of patients based on McGill Pain Questionnaire Short Form and EuroQol Five Dimensions Questionnaire. Four patients (11.76%) during MP treatment experienced mild or moderate side effects. None of the patients manifested CCS-associated neuropathic pain recurrence and MP-associated side effects at follow-up.
The current results suggested that MP offered an effective therapeutic alternative for relieving CCS-associated acute neuropathic pain with allodynia. Given the encouraging results of this study, it would be worthwhile to confirm these results in randomized placebo-controlled clinical trials.
中央脊髓综合征(CCS)可能伴有严重的神经性疼痛,这种疼痛常常对传统的疼痛治疗方案无效,并严重影响患者的生活质量(QoL)。目前针对CCS相关神经性疼痛的治疗方法,其疗效证据有限。本回顾性研究旨在探讨早期使用甲泼尼龙(MP)治疗对CCS患者急性神经性疼痛缓解及生活质量的影响。
收集患有伴有痛觉过敏的急性神经性疼痛的CCS患者的病历资料。所有患者接受静脉注射MP治疗,疗程长达1周。在基线、每日治疗期间以及MP治疗结束后1个月和3个月时,采用标准疗效指标对患者进行评估:神经性疼痛强度、痛觉过敏区域以及生活质量。
34例符合条件的患者纳入本研究。至MP治疗结束时,治疗后痛觉过敏完全或显著缓解(视觉模拟量表[VAS]评分降低50%或更多)的患者比例为91.18%,同时也观察到自发痛减轻。此外,本研究表明,基于麦吉尔疼痛问卷简表和欧洲五维健康量表,MP可显著改善患者的生活质量。4例患者(11.76%)在MP治疗期间出现轻度或中度副作用。随访期间,无患者出现CCS相关神经性疼痛复发及MP相关副作用。
目前的结果表明,MP为缓解伴有痛觉过敏的CCS相关急性神经性疼痛提供了一种有效的治疗选择。鉴于本研究取得的令人鼓舞的结果,在随机安慰剂对照临床试验中证实这些结果将是值得的。