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脊髓损伤患者疼痛管理干预措施的系统评价

A Systematic Review of the Interventions for Management of Pain in Patients After Spinal Cord Injury.

作者信息

Koukoulithras Ioannis, Alkhazi Abdulaziz, Gkampenis Athanasios, Stamouli Alexandra, Plexousakis Minas, Drousia Gianna, Xanthi Eleana, Roussos Charis, Kolokotsios Spyridon

机构信息

Department of Neurosurgery, University Hospital of Ioannina, Ioannina, GRC.

Faculty of Medicine, University of Ioannina, Ioannina, GRC.

出版信息

Cureus. 2023 Jul 29;15(7):e42657. doi: 10.7759/cureus.42657. eCollection 2023 Jul.

Abstract

Chronic pain is a very common problem in patients with spinal cord injury (SCI) as it affects 80% of these patients, which negatively affects their quality of life. Despite many advantages that exist in the management of any type of pain (neuropathic, nociceptive, mixed) in these patients, there is no cure, and the analgesic effect of some treatments is inadequate. This study aims to conduct an evidence-based systematic review regarding the various interventions used for the management of pain after SCI. The PubMed, Physiotherapy Evidence Database (PEDro), and Cochrane Library databases were searched from 1969 to 2023. The risk of bias was assessed using the PEDro scoring system. A total of 57 studies met the inclusion criteria and were included in this systematic review. Among the different interventions at present, 18 studies examined the role of oral medications, 11 studies examined the role of minimally invasive methods (injection and infusion), 16 studies investigated physiotherapy and alternative treatments, and 12 studies examined the role of repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and cranial electrotherapy stimulation (CES) in the management of pain in patients after SCI. Gabapentin and pregabalin are very effective in managing chronic neuropathic pain after SCI, and pregabalin also seems to reduce anxiety and sleep disturbances in the patients. It is noteworthy that lamotrigine, valproate, and carbamazepine do not have an analgesic effect, but mirogabalin is a novel and promising drug. Antidepressants (selective serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors) did not reduce the pain of the patients, although some studies showed an efficacy of amitriptyline especially in depressed patients and tramadol should be considered short-term with caution. Also, tDCS and rTMS reduced pain. Moreover, botulinum toxin type A, lidocaine, ketamine, and intrathecal baclofen significantly reduced pain intensity, although the sample of the studies was small. Physiotherapy and alternative treatments seem to relieve pain, and transcutaneous electrical nerve stimulation had the greatest reduction of pain intensity. In conclusion, several pharmaceutical and non-pharmaceutical methods exist, which can reduce pain in patients after SCI. The type of intervention can be considered by the physician depending on the patients' preference, age, medical history, type of pain, and associated symptoms. However, more studies with greater samples and with better methodological quality should be conducted.

摘要

慢性疼痛是脊髓损伤(SCI)患者中非常常见的问题,因为80%的此类患者都会受到影响,这对他们的生活质量产生了负面影响。尽管在管理这些患者的任何类型疼痛(神经性、伤害性、混合性)方面存在许多优势,但目前尚无治愈方法,而且一些治疗的镇痛效果并不理想。本研究旨在对用于脊髓损伤后疼痛管理的各种干预措施进行基于证据的系统评价。检索了1969年至2023年的PubMed、物理治疗证据数据库(PEDro)和考克兰图书馆数据库。使用PEDro评分系统评估偏倚风险。共有57项研究符合纳入标准并被纳入本系统评价。在目前的不同干预措施中,18项研究考察了口服药物的作用,11项研究考察了微创方法(注射和输注)的作用,16项研究调查了物理治疗和替代疗法,12项研究考察了重复经颅磁刺激(rTMS)、经颅直流电刺激(tDCS)和颅脑电刺激(CES)在脊髓损伤患者疼痛管理中的作用。加巴喷丁和普瑞巴林在管理脊髓损伤后的慢性神经性疼痛方面非常有效,普瑞巴林似乎还能减轻患者的焦虑和睡眠障碍。值得注意的是,拉莫三嗪、丙戊酸盐和卡马西平没有镇痛作用,但米罗加巴林是一种有前景的新型药物。抗抑郁药(选择性5-羟色胺再摄取抑制剂和5-羟色胺及去甲肾上腺素再摄取抑制剂)并没有减轻患者的疼痛,尽管一些研究表明阿米替林尤其对抑郁症患者有效,而曲马多应谨慎短期使用。此外,tDCS和rTMS减轻了疼痛。而且,A型肉毒毒素、利多卡因、氯胺酮和鞘内注射巴氯芬显著降低了疼痛强度,尽管研究样本较小。物理治疗和替代疗法似乎能缓解疼痛,经皮神经电刺激对疼痛强度的降低幅度最大。总之,存在多种药物和非药物方法可减轻脊髓损伤患者的疼痛。医生可根据患者的偏好、年龄、病史、疼痛类型和相关症状来考虑干预类型。然而,应该开展更多样本量更大、方法学质量更高的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a794/10461890/9615e6833385/cureus-0015-00000042657-i01.jpg

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