1Department of Clinical Neurological Sciences,Western University, London, Ontario,Canada.
2Department of Anesthesia,Pain Management & Perioperative Medicine,Dalhousie University, Halifax, Nova Scotia,Canada.
Can J Neurol Sci. 2018 Sep;45(5):545-552. doi: 10.1017/cjn.2018.55. Epub 2018 Jul 12.
Central neuropathic pain syndromes are a result of central nervous system injury, most commonly related to stroke, traumatic spinal cord injury, or multiple sclerosis. These syndromes are distinctly less common than peripheral neuropathic pain, and less is known regarding the underlying pathophysiology, appropriate pharmacotherapy, and long-term outcomes. The objective of this study was to determine the long-term clinical effectiveness of the management of central neuropathic pain relative to peripheral neuropathic pain at tertiary pain centers.
Patients diagnosed with central (n=79) and peripheral (n=710) neuropathic pain were identified for analysis from a prospective observational cohort study of patients with chronic neuropathic pain recruited from seven Canadian tertiary pain centers. Data regarding patient characteristics, analgesic use, and patient-reported outcomes were collected at baseline and 12-month follow-up. The primary outcome measure was the composite of a reduction in average pain intensity and pain interference. Secondary outcome measures included assessments of function, mood, quality of life, catastrophizing, and patient satisfaction.
At 12-month follow-up, 13.5% (95% confidence interval [CI], 5.6-25.8) of patients with central neuropathic pain and complete data sets (n=52) achieved a ≥30% reduction in pain, whereas 38.5% (95% CI, 25.3-53.0) achieved a reduction of at least 1 point on the Pain Interference Scale. The proportion of patients with central neuropathic pain achieving both these measures, and thus the primary outcome, was 9.6% (95% CI, 3.2-21.0). Patients with peripheral neuropathic pain and complete data sets (n=463) were more likely to achieve this primary outcome at 12 months (25.3% of patients; 95% CI, 21.4-29.5) (p=0.012).
Patients with central neuropathic pain syndromes managed in tertiary care centers were less likely to achieve a meaningful improvement in pain and function compared with patients with peripheral neuropathic pain at 12-month follow-up.
中枢神经性疼痛综合征是中枢神经系统损伤的结果，最常见于中风、外伤性脊髓损伤或多发性硬化症。这些综合征明显比周围神经性疼痛少见，对于其潜在的病理生理学、适当的药物治疗和长期结果了解较少。本研究的目的是确定在三级疼痛中心对中枢神经性疼痛的管理相对于周围神经性疼痛的长期临床效果。
从在加拿大七个三级疼痛中心招募的慢性神经性疼痛患者的前瞻性观察队列研究中，确定了中枢（n=79）和周围（n=710）神经性疼痛患者的分析对象。在基线和 12 个月随访时收集了患者特征、镇痛药使用情况和患者报告的结果数据。主要结局指标是平均疼痛强度和疼痛干扰的降低综合指标。次要结局指标包括功能、情绪、生活质量、灾难化和患者满意度的评估。
在 12 个月的随访中，有 13.5%（95%置信区间 [CI]，5.6-25.8）的中枢神经性疼痛患者和完整数据集（n=52）达到疼痛减轻≥30%，而 38.5%（95% CI，25.3-53.0）达到疼痛干扰量表至少降低 1 分。达到这两个指标（即主要结局）的中枢神经性疼痛患者的比例为 9.6%（95% CI，3.2-21.0）。完整数据集的周围神经性疼痛患者（n=463）在 12 个月时更有可能达到这一主要结局（25.3%的患者；95% CI，21.4-29.5）（p=0.012）。
在三级护理中心接受治疗的中枢神经性疼痛综合征患者在 12 个月的随访中，疼痛和功能改善的可能性低于周围神经性疼痛患者。
