Xu Mu-Lan, Wu Xiang-Bo, Liang Ying, Li Ning, Hu Xu, Lin Xiao-Dong, Sun Miao-Qiao, Dai Chun-Qiu, Niu Dan, Zhang Yan-Rong, Cao Hui, Zhao Chen-Guang, Sun Xiao-Long, Yuan Hua
Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, Shaanxi, People's Republic of China.
Department of Rehabilitation Medicine, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, Guangdong, People's Republic of China.
J Pain Res. 2023 Jul 27;16:2619-2632. doi: 10.2147/JPR.S414638. eCollection 2023.
Neuropathic pain (NP) is a common and severe problem following spinal cord injury (SCI). However, its relationship with functional outcome remains unclear.
A retrospective explorative analysis was performed on SCI patients admitted to a tertiary academic medical center between January 2018 and June 2022. The candidate predictor variables, including demographics, clinical characteristics and complications, were analyzed with logistic and linear regression. Spinal Cord Independence Measure (SCIM) scores at discharge and mean relative functional gain (mRFG) of SCIM were as outcome parameters.
A total of 140 SCI patients included for the final analysis. Among them, 44 (31.43%) patients were tetraplegics, and 96 (68.57%) patients were paraplegics; 68 (48.57%) patients developed NP, and 72 (51.43%) patients did not. Logistic and linear regression analyses of SCIM at discharge both showed that NP [OR=3.10, 95% CI (1.29,7.45), =0.01; unstandardized β=11.47, 95% CI (4.95,17.99), <0.01; respectively] was significantly independent predictors for a favorable outcome (SCIM at discharge ≥ 50, logistic regression results) and higher SCIM total score at discharge (linear regression results). Besides, NP [unstandardized β=15.67, 95% CI (8.94,22.41), <0.01] was also independently associated with higher mRFG of SCIM scores. Furthermore, the NP group had significantly higher mRFG, SCIM total scores and subscales (self-care, respiration and sphincter management, and mobility) at discharge compared to the non-NP group. However, there were no significant differences in mRFG, SCIM total score or subscales at discharge among the NP subgroups in terms of locations (at level pain, below level pain, and both) or timing of occurrence (within and after one month after SCI). This study also showed that incomplete injury, lumbar-sacral injury level and non-anemia were significantly independent predictors for a favorable outcome, and higher mRFG of SCIM scores (except for non-anemia).
NP appears independently associated with better functional recovery in SCI patients, suggesting the bright side of this undesirable complication. These findings may help to alleviate the psychological burden of NP patients and ultimately restore their confidence in rehabilitation.
神经性疼痛（NP）是脊髓损伤（SCI）后常见且严重的问题。然而，其与功能结局的关系仍不明确。
对2018年1月至2022年6月入住一家三级学术医学中心的SCI患者进行回顾性探索性分析。使用逻辑回归和线性回归分析包括人口统计学、临床特征和并发症在内的候选预测变量。出院时的脊髓独立测量（SCIM）评分和SCIM的平均相对功能增益（mRFG）作为结局参数。
共140例SCI患者纳入最终分析。其中，44例（31.43%）患者为四肢瘫，96例（68.57%）患者为截瘫；68例（48.57%）患者发生NP，72例（51.43%）患者未发生。出院时SCIM的逻辑回归和线性回归分析均显示，NP [OR=3.10，95%CI（1.29，7.45），P=0.01；非标准化β=11.47，95%CI（4.95，17.99），P<0.01；分别]是良好结局（出院时SCIM≥50，逻辑回归结果）和出院时较高SCIM总分（线性回归结果）的显著独立预测因素。此外，NP [非标准化β=15.67，95%CI（8.94，22.41），P<0.01]也与SCIM评分的较高mRFG独立相关。此外，与非NP组相比，NP组出院时的mRFG、SCIM总分及各子量表（自我护理、呼吸和括约肌管理以及移动性）显著更高。然而，NP亚组在出院时的mRFG、SCIM总分或子量表在疼痛部位（疼痛平面、疼痛平面以下及两者）或发生时间（SCI后1个月内及1个月后）方面无显著差异。本研究还表明，不完全损伤、腰骶部损伤平面和非贫血是良好结局以及SCIM评分较高mRFG（非贫血除外）的显著独立预测因素。
NP似乎与SCI患者更好的功能恢复独立相关，提示这种不良并发症的积极一面。这些发现可能有助于减轻NP患者的心理负担，并最终恢复他们对康复的信心。
