Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA
Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Reg Anesth Pain Med. 2021 Apr;46(4):328-336. doi: 10.1136/rapm-2020-101960. Epub 2021 Jan 6.
The reported prevalence of chronic pain after spinal cord injury (SCI) varies widely due, in part, to differences in the taxonomy of chronic pain. A widely used classification system is available to describe subcategories of chronic pain in SCI, but the prevalence of chronic pain in SCI based on this system is unknown.
The primary objective of this systematic review and meta-analysis is to determine the prevalence of chronic pain after SCI based on the International Spinal Cord Injury Pain (ISCIP) classification system.
A comprehensive search of databases from January 1980 to August 2019 was conducted. The risk of bias was assessed using a modified tool developed for uncontrolled studies. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess certainty in prevalence estimates.
A total of 1305 records were screened, and 37 studies met inclusion criteria. The pooled prevalence of overall chronic pain was 68% (95% CI 63% to 73%). The pooled prevalence of neuropathic pain in 13 studies was 58% (95% CI 49% to 68%); the pooled prevalence of musculoskeletal pain in 11 studies was 56% (95% CI 41% to 70%); the pooled prevalence of visceral pain in 8 studies was 20% (95% CI 11% to 29%) and the pooled prevalence of nociceptive pain in 2 studies was 45% (95% CI 13% to 78%). Meta-regression of risk of bias (p=0.20), traumatic versus non-traumatic etiology of injury (p=0.59), and studies where pain was a primary outcome (p=0.32) demonstrated that these factors were not significant moderators of heterogeneity. Certainty in prevalence estimates was judged to be low due to unexplained heterogeneity.
This systematic review and meta-analysis extends the findings of previous studies by reporting the prevalence of chronic pain after SCI based on the ISCIP classification system, thereby reducing clinical heterogeneity in the reporting of pain prevalence related to SCI.
由于慢性疼痛分类的差异，脊髓损伤（SCI）后慢性疼痛的报告发生率差异很大。目前有一个广泛使用的分类系统可用于描述 SCI 中慢性疼痛的亚类，但基于该系统的 SCI 慢性疼痛发生率尚不清楚。
本系统评价和荟萃分析的主要目的是根据国际脊髓损伤疼痛（ISCIP）分类系统确定 SCI 后慢性疼痛的发生率。
从 1980 年 1 月到 2019 年 8 月，对数据库进行了全面检索。使用针对非对照研究开发的改良工具评估偏倚风险。使用推荐评估、制定与评价分级方法评估发生率估计的确定性。
共筛选出 1305 条记录，37 项研究符合纳入标准。总体慢性疼痛的汇总发生率为 68%（95%CI，63%73%）。13 项研究中神经性疼痛的汇总发生率为 58%（95%CI，49%68%）；11 项研究中肌肉骨骼疼痛的汇总发生率为 56%（95%CI，41%70%）；8 项研究中内脏疼痛的汇总发生率为 20%（95%CI，11%29%）；2 项研究中伤害性疼痛的汇总发生率为 45%（95%CI，13%~78%）。偏倚风险的元回归（p=0.20）、损伤的创伤性与非创伤性病因（p=0.59）以及疼痛为主要结局的研究（p=0.32）表明，这些因素不是异质性的显著调节因素。由于异质性无法解释，因此对发生率估计的确定性判断为低。
本系统评价和荟萃分析通过报告基于 ISCIP 分类系统的 SCI 后慢性疼痛发生率，扩展了先前研究的发现，从而减少了与 SCI 相关疼痛发生率报告中的临床异质性。
