Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185, Linköping, Sweden.
Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, 221 85, Lund, Sweden.
BMC Musculoskelet Disord. 2023 May 6;24(1):357. doi: 10.1186/s12891-023-06462-2.
Neuropathic pain arises as a direct consequence of a lesion or disease affecting the somatosensory system. Pharmacological treatments for neuropathic pain often fail despite following guidelines. Interdisciplinary Pain Rehabilitation Programs (IPRP) are an effective intervention for chronic pain conditions. Little research has investigated whether IPRP can benefit patients with chronic neuropathic pain compared to other chronic pain conditions. This study assesses the real-world effects of IPRP on patients with chronic neuropathic pain compared to non-neuropathic patients using Patient-Reported Outcome Measures (PROMs) available in the Swedish Quality Registry for Pain Rehabilitation (SQRP).
A neuropathic group of patients (n = 1,654) were identified in two steps. This group was compared to a non-neuropathic group (n = 14,355) composed of common diagnoses (low back pain, fibromyalgia, whiplash associated disorders, and Ehlers-Danlos Syndrome) in relation to background variables, three overall outcome variables, and mandatory outcome variables (pain intensity, psychological distress symptoms, activity/participation aspects and health-related quality of life variables). Of these patients 43-44% participated in IPRP.
At assessment, the neuropathic group reported significantly (with small effect sizes (ES)) more physician visits the previous year, older age, shorter pain durations, and less spatial extent of the pain (moderate ES). Moreover, for the 22 mandatory outcome variables, we found only clinically insignificant differences according to ESs between the groups. For patients participating in IPRP, the neuropathic group displayed equal or in some cases slightly superior results compared to the non-neuropathic group.
After assessing the real-world effects of IPRP, this large study found that neuropathic pain patients can benefit from the IPRP intervention. Both registry studies and RCTs are needed to better understand which patients with neuropathic pain are most suitable for IPRP and to what extent special considerations need to be made for these patients within the framework of IPRP.
神经病理性疼痛是由于躯体感觉系统的损伤或疾病直接引起的。尽管遵循了指南，但对于神经病理性疼痛的药物治疗往往仍会失败。跨学科疼痛康复计划（IPRP）是治疗慢性疼痛疾病的有效干预措施。很少有研究调查 IPRP 是否可以使慢性神经病理性疼痛患者受益，与其他慢性疼痛疾病相比。本研究使用瑞典疼痛康复质量登记处（SQRP）中可用的患者报告结局测量（PROM），评估 IPRP 对慢性神经病理性疼痛患者的真实世界效果，与非神经病理性患者相比。
分两步确定了神经病理性患者组（n=1654）。该组与非神经病理性组（n=14355）进行比较，非神经病理性组由常见诊断（下腰痛、纤维肌痛、挥鞭样损伤和埃勒斯-当洛斯综合征）组成，比较了背景变量、三个总体结局变量和强制性结局变量（疼痛强度、心理困扰症状、活动/参与方面和健康相关生活质量变量）。这些患者中有 43-44%参加了 IPRP。
在评估时，神经病理性组报告前一年的就诊次数明显更多（具有小的效应大小（ES）），年龄更大，疼痛持续时间更短，疼痛的空间范围更小（中等 ES）。此外，对于 22 个强制性结局变量，我们发现两组之间仅存在临床无意义的差异，根据 ES。对于参加 IPRP 的患者，神经病理性组的结果与非神经病理性组相等或在某些情况下略优。
在评估 IPRP 的真实世界效果后，这项大型研究发现，神经病理性疼痛患者可以从 IPRP 干预中受益。需要进行登记研究和 RCT，以更好地了解哪些神经病理性疼痛患者最适合 IPRP，以及在 IPRP 框架内，这些患者需要考虑哪些特殊因素。
