Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Eur J Pain. 2020 Sep;24(8):1548-1568. doi: 10.1002/ejp.1608. Epub 2020 Jul 21.
Pain is common and refractory in spinal cord injury (SCI). Currently, most studies evaluated pain in male-predominant traumatic-SCI. Also, concomitant secondary pain syndromes and its temporal evolution were seldom reported.
We aimed to prospectively describe the main and secondary pain and its associated factors in inflammatory-SCI evaluating neuromyelitis optica (NMO) patients. In-remission NMO patients underwent neurological, imaging and autoantibody evaluations. Questionnaires detailing main and secondary pains, functional state, mood, catastrophizing, quality of life (QoL) and "non-motor symptoms" were used at two time points.
Pain was present in 53 (73.6%) of the 72 patients included. At-level neuropathic pain was the most common main pain syndrome, affecting 32 subjects (60.4% of those with pain). Over 70% (n = 38) of this cohort reported two pain syndromes. Those without pain were significantly younger (26.1 ± 12.7 y.o. in those without pain and 40.1 ± 12.5, 37.2 ± 11.4 y.o. in those whose main pain was neuropathic and non-neuropathic, respectively, p = .001), and no differences in the inflammatory status were observed between groups. On follow-up, one-fifth (n = 11) had a different main pain syndrome from the first visit. Pain impacted QoL as much as disability and motor strength.
Pain is a prevalent and disabling non-motor symptom in NMO-SCI. Most patients experience more than one pain syndrome which can change in time even in the absence of clinical relapse. Age of the inflammatory-SCI was a major determinant of pain. Acknowledging temporal changes and multiplicity of pain syndromes in NMO-SCI may give insights into more precise designs of clinical trials and general management of pain in SCI.
In this longitudinal study with NMO-related SCI, pain affected almost three-quarters of patients with NMO. Over 70% have more than one pain syndrome and at-level neuropathic pain is the most common type of pain syndrome. Patients without pain were significantly younger but had the same burden of inflammatory lesions than those with pain. During follow-up, up to one fifth of patients presented with changes in the main pain syndromes, which can occur even in the absence of clinical activity of the inflammatory disease. In this cohort, Pain affected quality of life as much as disability or motor strength.
脊髓损伤（SCI）患者常出现疼痛且难以缓解。目前，大多数研究评估的是男性为主的外伤性 SCI 患者的疼痛情况。此外，很少有研究报告同时存在的继发性疼痛综合征及其时间演变。
我们旨在前瞻性描述炎症性 SCI 患者中主要和继发性疼痛及其相关因素，评估视神经脊髓炎（NMO）患者。处于缓解期的 NMO 患者接受了神经学、影像学和自身抗体评估。在两个时间点使用详细描述主要和继发性疼痛、功能状态、情绪、灾难化、生活质量（QoL）和“非运动症状”的问卷进行评估。
72 名患者中，53 名（73.6%）存在疼痛。同水平神经病理性疼痛是最常见的主要疼痛综合征，影响 32 名患者（疼痛患者中 60.4%）。该队列中超过 70%（n=38）的患者报告存在两种疼痛综合征。无疼痛的患者明显更年轻（无疼痛患者为 26.1±12.7 岁，主要为神经病理性和非神经病理性疼痛的患者分别为 40.1±12.5 和 37.2±11.4 岁，p=0.001），且各组之间的炎症状态无差异。随访时，五分之一（n=11）的患者的主要疼痛综合征与第一次就诊时不同。疼痛对 QoL 的影响与残疾和运动力量相当。
疼痛是 NMO-SCI 中常见且致残的非运动症状。大多数患者经历一种以上的疼痛综合征，即使在没有临床复发的情况下，疼痛综合征也会随时间变化。炎症性 SCI 的发病年龄是疼痛的主要决定因素。了解 NMO-SCI 中疼痛综合征的时间变化和多样性，可能有助于更精确地设计临床试验和更全面地管理 SCI 患者的疼痛。
在这项针对 NMO 相关 SCI 的纵向研究中，疼痛影响了近四分之三的 NMO 患者。超过 70%的患者存在不止一种疼痛综合征，同水平神经病理性疼痛是最常见的疼痛综合征类型。无疼痛的患者明显更年轻，但与有疼痛的患者炎症病变负担相同。在随访期间，多达五分之一的患者主要疼痛综合征发生变化，即使在炎症性疾病无临床活动的情况下也可能发生。在该队列中，疼痛对生活质量的影响与残疾或运动力量相当。
