Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA.
Department of Anesthesiology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA.
Adv Ther. 2020 May;37(5):1946-1959. doi: 10.1007/s12325-020-01334-w. Epub 2020 Apr 10.
This is a comprehensive review of the current literature on central neuropathic pain mechanisms that is secondary to spinal cord injury. It reviews recent and seminal findings on the pathophysiology, diagnosis, and treatment and compares treatment options and recommendations.
Neuropathic pain (NP) is a common complication of spinal cord injury (SCI). Chronicity of NP is attributed to increased abundance of inflammatory mediators and ion channel dysfunction leading to afferent nerve sensitization; nerve damage and nerve-glia cross talk have also been implicated. Conventional treatment is medical and has had limited success. Recent studies have made headway in identifying novel biomarkers, including microRNA and psychosocial attributes that can predict progress from SCI to chronic NP (CNP). Recent advances have provided evidence of efficacy for two promising drugs. Baclofen was able to provide good, long-lasting pain relief. Ziconotide, a voltage-gated calcium channel blocker, was studied in a small trial and was able to provide good analgesia in most participants. However, several participants had to be withdrawn because of worrisome creatine phosphokinase (CPK) elevations, and further studies are required to define its safety profile. Non-medical interventions include brain sensitization and biofeedback techniques. These methods have recently had encouraging results, albeit preliminary. Case reports of non-conventional techniques, such as hypnosis, were also reported. CNP is a common complication of SCI and is a prevalent disorder with significant morbidity and disability. Conventional medical treatment is limited in efficacy. Recent studies identified baclofen and ziconotide as possible new therapies, alongside non-medical interventions. Further research into the pathophysiology is required to identify further therapy candidates. A multidisciplinary approach, including psychosocial support, medical and non-medical interventions, is likely needed to achieve therapeutic effects in this difficult to treat syndrome.
这是一篇对脊髓损伤后中枢性神经病理性疼痛机制的综合文献综述，主要回顾了该领域近期的开创性发现，包括病理生理学、诊断和治疗，并比较了治疗方案和建议。
神经病理性疼痛（NP）是脊髓损伤（SCI）的常见并发症。NP 的慢性化归因于炎症介质的丰度增加和离子通道功能障碍导致传入神经敏化；神经损伤和神经胶质细胞相互作用也与此有关。传统的治疗方法是药物治疗，但效果有限。最近的研究在识别新的生物标志物方面取得了进展，包括 microRNA 和心理社会特征，这些生物标志物可以预测 SCI 向慢性 NP（CNP）的进展。最近的进展为两种有前途的药物提供了疗效证据。巴氯芬能提供良好、持久的疼痛缓解。电压门控钙通道阻滞剂 Ziconotide 在一项小型试验中进行了研究，大多数参与者都能获得良好的镇痛效果。然而，由于令人担忧的肌酸磷酸激酶（CPK）升高，有几名参与者不得不退出试验，需要进一步研究来确定其安全性。非医学干预措施包括大脑致敏和生物反馈技术。这些方法最近取得了令人鼓舞的结果，尽管还处于初步阶段。也有报告称使用了非常规技术，如催眠术，来治疗案例。CNP 是 SCI 的常见并发症，是一种普遍存在的疾病，发病率和致残率都很高。传统的医学治疗效果有限。最近的研究发现巴氯芬和 Ziconotide可能是新的治疗方法，同时还有非医学干预措施。需要进一步研究病理生理学，以确定更多的治疗候选药物。多学科方法，包括心理社会支持、医学和非医学干预，可能需要在这种难以治疗的综合征中实现治疗效果。
