Kumru Hatice, Kofler Markus, Albu Sergiu, Vidal Joan, Benito Jesus
Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Camí Can Ruti s/n., 08916, Badalona, Barcelona, Spain.
Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
Acta Neurol Belg. 2024 Oct;124(5):1631-1640. doi: 10.1007/s13760-024-02524-x. Epub 2024 May 19.
Long-term analgesic effect of intrathecal baclofen was reported in individuals with spinal cord injury. We conducted a prospective study to evaluate the effect of intrathecal baclofen on subtypes of neuropathic pain and its interference with general activity.
Nine spinal cord injury individuals who presented with severe spasticity and moderate to severe neuropathic pain received intrathecal baclofen via an implanted pump. We applied the ASIA Impairment Scale to assess spinal cord injury severity. Neuropathic pain was evaluated by numerical rating scale, Neuropathic Pain Symptom Inventory, and Brief Pain Inventory. Evaluations were performed at baseline and after at least 6 months of continuous intrathecal baclofen treatment.
Intrathecal baclofen led to significant pain reduction as measured by numerical rating scale, Neuropathic Pain Symptom Inventory, and Brief Pain Inventory (p < 0.05). Improvements were significant for paroxysmal pain and dysesthesia and for pain interference with general activity, as assessed by the Brief Pain Inventory (p < 0.05). There was a significant relationship between the time since spinal cord injury and changes in paroxysmal pain as well as in the total Neuropathic Pain Symptom Inventory score (p < 0.05). The baclofen dose correlated also to the percentage changes in neuropathic pain improvement and sleep (p < 0.003).
The present results provide evidence that intrathecal baclofen effectively reduces neuropathic pain, particularly paroxysmal pain and dysesthesia, and improves pain interference and overall well-being in individuals with spinal cord injury. Clinicians should be aware of this less well-known beneficial effect of intrathecal baclofen and should consider such a treatment option for better control of neuropathic pain in individuals with spinal cord injury.
有报道称鞘内注射巴氯芬对脊髓损伤患者具有长期镇痛作用。我们进行了一项前瞻性研究，以评估鞘内注射巴氯芬对神经性疼痛亚型的影响及其对日常活动的干扰。
9名患有严重痉挛和中度至重度神经性疼痛的脊髓损伤患者通过植入式泵接受鞘内注射巴氯芬治疗。我们应用美国脊髓损伤协会（ASIA）损伤量表评估脊髓损伤的严重程度。通过数字评分量表、神经性疼痛症状量表和简明疼痛量表评估神经性疼痛。在基线时以及连续鞘内注射巴氯芬治疗至少6个月后进行评估。
通过数字评分量表、神经性疼痛症状量表和简明疼痛量表测量，鞘内注射巴氯芬导致疼痛显著减轻（p<0.05）。根据简明疼痛量表评估，阵发性疼痛、感觉异常以及疼痛对日常活动的干扰均有显著改善（p<0.05）。脊髓损伤后的时间与阵发性疼痛的变化以及神经性疼痛症状量表总分之间存在显著相关性（p<0.05）。巴氯芬剂量也与神经性疼痛改善和睡眠的百分比变化相关（p<0.003）。
目前的结果表明，鞘内注射巴氯芬可有效减轻神经性疼痛，尤其是阵发性疼痛和感觉异常，并改善脊髓损伤患者的疼痛干扰和整体健康状况。临床医生应了解鞘内注射巴氯芬这种鲜为人知的有益作用，并应考虑将这种治疗方法作为更好地控制脊髓损伤患者神经性疼痛的选择。
