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神经性疼痛的运动疗法:系统评价与专家共识

Exercise for Neuropathic Pain: A Systematic Review and Expert Consensus.

作者信息

Zhang Yong-Hui, Hu Hao-Yu, Xiong Yuan-Chang, Peng Changgeng, Hu Li, Kong Ya-Zhuo, Wang Yu-Ling, Guo Jia-Bao, Bi Sheng, Li Tie-Shan, Ao Li-Juan, Wang Chu-Huai, Bai Yu-Long, Fang Lei, Ma Chao, Liao Lin-Rong, Liu Hao, Zhu Yi, Zhang Zhi-Jie, Liu Chun-Long, Fang Guo-En, Wang Xue-Qiang

机构信息

Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.

Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China.

出版信息

Front Med (Lausanne). 2021 Nov 24;8:756940. doi: 10.3389/fmed.2021.756940. eCollection 2021.

Abstract

Neuropathic pain (NP), a severe and disruptive symptom following many diseases, normally restricts patients' physical functions and leads to anxiety and depression. As an economical and effective therapy, exercise may be helpful in NP management. However, few guidelines and reviews focused on exercise therapy for NP associated with specific diseases. The study aimed to summarize the effectiveness and efficacy of exercise for various diseases with NP supported by evidence, describe expert recommendations for NP from different causes, and inform policymakers of the guidelines. A systematic review and expert consensus. A systematic search was conducted in PubMed. We included systematic review and meta-analysis, randomized controlled trials (RCTs), which assessed patients with NP. Studies involved exercise intervention and outcome included pain intensity at least. Physiotherapy Evidence Database and the Assessment of Multiple Systematic reviews tool were used to grade the quality assessment of the included RCTs and systematic reviews, respectively. The final grades of recommendation were based on strength of evidence and a consensus discussion of results of Delphi rounds by the Delphi consensus panel including 21 experts from the Chinese Association of Rehabilitation Medicine. Eight systematic reviews and 21 RCTs fulfilled all of the inclusion criteria and were included, which were used to create the 10 evidence-based consensus statements. The 10 expert recommendations regarding exercise for NP symptoms were relevant to the following 10 different diseases: spinal cord injury, stroke, multiple sclerosis, Parkinson's disease, cervical radiculopathy, sciatica, diabetic neuropathy, chemotherapy-induced peripheral neuropathy, HIV/AIDS, and surgery, respectively. The exercise recommended in the expert consensus involved but was not limited to muscle stretching, strengthening/resistance exercise, aerobic exercise, motor control/stabilization training and mind-body exercise (Tai Chi and yoga). Based on the available evidence, exercise is helpful to alleviate NP intensity. Therefore, these expert consensuses recommend that proper exercise programs can be considered as an effective alternative treatment or complementary therapy for most patients with NP. The expert consensus provided medical staff and policymakers with applicable recommendations for the formulation of exercise prescription for NP. This consensus statement will require regular updates after five-ten years.

摘要

神经病理性疼痛(NP)是许多疾病后出现的一种严重且具有破坏性的症状,通常会限制患者的身体功能,并导致焦虑和抑郁。作为一种经济有效的治疗方法,运动可能有助于NP的管理。然而,很少有指南和综述关注与特定疾病相关的NP的运动疗法。本研究旨在总结有证据支持的运动对各种伴有NP的疾病的有效性和疗效,描述针对不同病因NP的专家建议,并为政策制定者提供指南信息。一项系统综述和专家共识。在PubMed中进行了系统检索。我们纳入了评估NP患者的系统综述和荟萃分析、随机对照试验(RCT)。研究涉及运动干预,结局至少包括疼痛强度。分别使用物理治疗证据数据库和多重系统综述评估工具对纳入的RCT和系统综述进行质量评估分级。最终的推荐等级基于证据强度以及由来自中国康复医学会的21名专家组成的德尔菲共识小组对德尔菲轮次结果的共识讨论。八项系统综述和21项RCT符合所有纳入标准并被纳入,用于制定10条基于证据的共识声明。关于NP症状运动的10条专家建议分别与以下10种不同疾病相关:脊髓损伤、中风、多发性硬化症、帕金森病、颈神经根病、坐骨神经痛、糖尿病性神经病变、化疗引起的周围神经病变、HIV/AIDS和手术。专家共识中推荐的运动包括但不限于肌肉拉伸、强化/抗阻运动、有氧运动、运动控制/稳定训练和身心运动(太极拳和瑜伽)。基于现有证据,运动有助于减轻NP强度。因此,这些专家共识建议,对于大多数NP患者,适当的运动方案可被视为一种有效的替代治疗或辅助治疗方法。专家共识为医护人员和政策制定者提供了针对NP制定运动处方的适用建议。本共识声明将在五到十年后定期更新。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/78b1/8654102/9d95cd86f665/fmed-08-756940-g0001.jpg

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