Hecht Jeffrey S, Moore Kyle L Johnson, Roberts Roy F
Division of Surgical Rehabilitation, Department of Surgery, University of Tennessee, Knoxville, Knoxville, Tennessee, United States.
Office of Research, University of Tennessee Health Science Center, Memphis, Tennessee, United States.
Arch Rehabil Res Clin Transl. 2024 Apr 27;6(2):100338. doi: 10.1016/j.arrct.2024.100338. eCollection 2024 Jun.
To determine whether chronic pain persists after complete spinal cord injury (SCI).
Prospective observational study regarding the outcome of pre-existent chronic pain of inpatients admitted with new clinically diagnosed complete cervical SCI. For patients who acknowledged chronic pain of ≥3 years duration before the SCI, further questions explored whether they still experienced that pain, whether they were experiencing current posttraumatic pain, and whether they had any past exposure to opioids. The included patients were identified during the initial consultation in the trauma center for treatment of the SCI.
Level I trauma center.
From a total of 49 participants with acute cervical SCI with clinically diagnosed complete motor and sensory tetraplegia admitted between 2018 and 2020, 7 were selected on the basis of a history of chronic pain.
Collected complete history and performed physical examination with serial follow-ups during the acute hospital stay until death or discharge.
The primary outcome was a finding of chronic pain experienced before new clinical diagnosis of complete SCI, compared with whether or not that pain continued after the SCI injury. The secondary outcome was the relation of persistent pain with opioid use; it was formulated after data collection.
Among 49 patients with clinically diagnosed complete cervical SCIs, 7 had experienced prior chronic pain. Four participants experienced a continuation of the prior pain after their complete tetraplegia (4/7), whereas 3 participants did not (3/7). All the participants with continued pain had been previously treated with opioids, whereas those whose pain ceased had not received chronic opioid therapy.
There may be a unique form of chronic pain that is based in the brain, irrespective of peripheral pain or spinal mechanisms. Otherwise healthy people with longstanding antecedent chronic pain whose pain persists after acute clinically complete SCI with tetraplegia may provide a new model for evaluation of brain-based pain. Opioids may be requisite for this type of pain.
确定慢性疼痛在完全性脊髓损伤（SCI）后是否持续存在。
关于新临床诊断为完全性颈髓损伤的住院患者既往慢性疼痛结局的前瞻性观察性研究。对于在脊髓损伤前已确认存在持续≥3年慢性疼痛的患者，进一步询问他们是否仍有该疼痛、是否正在经历当前的创伤后疼痛以及他们过去是否使用过阿片类药物。纳入的患者是在创伤中心首次会诊治疗脊髓损伤期间确定的。
一级创伤中心。
在2018年至2020年期间收治的49例急性颈髓损伤且临床诊断为完全性运动和感觉性四肢瘫的患者中，根据慢性疼痛病史选取了7例。
收集完整病史，并在急性住院期间进行体格检查及系列随访，直至死亡或出院。
主要结局是在新临床诊断为完全性脊髓损伤之前经历的慢性疼痛，与脊髓损伤后该疼痛是否持续相比较。次要结局是持续性疼痛与阿片类药物使用的关系；在数据收集后制定。
在49例临床诊断为完全性颈髓损伤的患者中，7例曾经历过慢性疼痛。4例参与者在完全性四肢瘫后仍持续先前的疼痛（4/7），而3例参与者则没有（3/7）。所有疼痛持续的参与者之前都接受过阿片类药物治疗，而疼痛停止的参与者未接受过慢性阿片类药物治疗。
可能存在一种独特的基于大脑的慢性疼痛形式，与外周疼痛或脊髓机制无关。既往有长期慢性疼痛且在急性临床完全性脊髓损伤伴四肢瘫后疼痛仍持续的健康人，可能为评估基于大脑的疼痛提供一种新模型。阿片类药物可能是这类疼痛所必需的。
