The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510006, China.
Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Guangzhou, 510120, China.
BMC Neurol. 2022 Aug 19;22(1):304. doi: 10.1186/s12883-022-02841-9.
Neuropathic pain is a common complication in neuromyelitis optica spectrum disorder (NMOSD), which seriously affects the quality of life of NMOSD patients, with no satisfactory treatment. And risk factors of neuropathic pain are still uncertain.
To investigate the risk factors of neuropathic pain in a NMOSD cohort.
Our study was a retrospective case-cohort study, the patients diagnosed with NMOSD in the Department of Neurology from the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2011 to October 2021 were screened. Inclusion criteria were: (1) patients diagnosed as NMOSD according to the International Panel for NMO Diagnosis (IPND) criteria, (2) the aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) test was performed. Patients without AQP4-IgG antibody were excluded. Clinical data, including sex, age of the first onset, symptoms of the first episode including neuropathic pain and attack types, localization of lesions of the first episode on Magnetic Resonance Imaging (MRI), Extended disability status Scale (EDSS) of the first onset, treatment of immunosuppression in the first acute phase, disease modifying therapy (DMT), treatment of neuropathic pain and APQ4-IgG status were collected from the hospital system database. Neuropathic pain was defined according to the International Association for the Study of Pain criteria and was described as "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system".
One hundred nineteen patients were screened and finally 86 patients fulfilling the inclusion and exclusion criteria were enrolled in our study. The prevalence of neuropathic pain in patients with NMOSD was 43.0%. Univariate analysis showed that the factors associated with neuropathic pain were the age at the onset, the attack type of optic neuritis, the attack type of myelitis, length of spinal cord involvement, localization of thoracic lesion, optic lesion, upper thoracic lesions, lower thoracic lesions, extended spinal cord lesions (≥ 3 spinal lesions), extended thoracic lesions (≥ 4 thoracic lesions), intravenous immunoglobulin and mycophenolate mofetil. Multivariate regression analysis showed that extended thoracic lesions (OR 20.21 [1.18-346.05], P = 0.038) and age (OR 1.35 (1-1.81) P = 0.050) were independently associated with neuropathic pain among NMOSD patients and that gender (OR 12.11 (0.97-151.64) P = 0.053) might be associated with neuropathic pain among NMOSD patients.
Extended thoracic lesions (≥ 4 thoracic lesions), age and gender might be independent risk factors of neuropathic pain among patients with NMOSD. However, with a small sample size and predominantly female, caution must be applied and these results need validating in further cohorts.
神经病理性疼痛是视神经脊髓炎谱系疾病（NMOSD）的常见并发症，严重影响 NMOSD 患者的生活质量，目前尚无满意的治疗方法。而神经病理性疼痛的危险因素仍不确定。
探讨 NMOSD 队列中神经病理性疼痛的危险因素。
本研究为回顾性病例对照研究，筛选 2011 年 1 月至 2021 年 10 月于广州中医药大学第二附属医院神经内科确诊的 NMOSD 患者。纳入标准为：（1）根据国际 NMOSD 诊断小组（IPND）标准诊断为 NMOSD；（2）进行水通道蛋白 4 免疫球蛋白 G 抗体（AQP4-IgG）检测。排除无 AQP4-IgG 抗体的患者。从医院系统数据库中收集临床数据，包括性别、首发年龄、首发症状包括神经病理性疼痛和发作类型、首发 MRI 病变定位、首发扩展残疾状况量表（EDSS）、首发急性期免疫抑制治疗、疾病修正治疗（DMT）、神经病理性疼痛治疗和 AQP4-IgG 状态。神经病理性疼痛根据国际疼痛研究协会标准定义为“直接由影响躯体感觉系统的病变或疾病引起的疼痛”。
筛选出 119 例患者，最终纳入符合纳入和排除标准的 86 例患者。NMOSD 患者神经病理性疼痛的患病率为 43.0%。单因素分析显示，与神经病理性疼痛相关的因素为发病年龄、视神经炎发作类型、脊髓炎发作类型、脊髓受累长度、胸段病变定位、视神经病变、上胸段病变、下胸段病变、扩展脊髓病变（≥3 个脊髓病变）、扩展胸段病变（≥4 个胸段病变）、静脉注射免疫球蛋白和霉酚酸酯。多因素回归分析显示，扩展胸段病变（OR 20.21[1.18-346.05]，P=0.038）和年龄（OR 1.35[1-1.81]，P=0.050）是 NMOSD 患者神经病理性疼痛的独立相关因素，而性别（OR 12.11[0.97-151.64]，P=0.053）可能与 NMOSD 患者神经病理性疼痛有关。
扩展胸段病变（≥4 个胸段病变）、年龄和性别可能是 NMOSD 患者神经病理性疼痛的独立危险因素。然而，由于样本量小且主要为女性，需要谨慎对待这些结果，并在进一步的队列中验证。
