McGennis Marie-Ève, Gagnon Marc-Aurèle, Paquet Jérôme, Turgeon Alexis F, Macedo Tassia, Côté Caroline, Matina Mwanack Kakule, Verret Michael, Moore Lynne, Richard-Denis Andréane, Guénette Line, Archambault Léonie, Duval Cécile, Bérubé Mélanie
Population Health and Optimal Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Center, Québec City, Canada.
Faculty of Nursing, Université Laval, Québec City, Canada.
Neurotrauma Rep. 2025 Aug 19;6(1):686-699. doi: 10.1177/08977151251365585. eCollection 2025.
Pain is prevalent and a major source of disability after a traumatic brain injury (TBI) and a spinal cord injury (SCI). With a view of reducing the pain burden in neurotrauma, this study aimed to describe the use of pain management strategies and the adverse effects of opioids in patients with TBI and SCI. We collected data at hospital discharge (T1) and at 3 months post-injury (T2). A total of 70 patients, including 49 with TBI and 21 with SCI, with a mean age of 56 years (±21.1, ±17.9) were included. Almost a third of participants with TBI (33%) and SCI (29%) had a moderate average pain intensity at T1, and most experienced mild average pain intensity at T2. At T1, 80% of participants used opioids, whereas at T2, 26% of participants with TBI and 53% of those with SCI did. The main co-analgesic used was acetaminophen, with 78% and 17% for participants with TBI and 81% and 40% for participants with SCI at T1 and T2. The most common non-pharmacological strategy in participants with TBI was rest at T1 (45%) and T2 (32%), and comfortable positioning in participants with SCI at both timepoints (81% and 53%). The two most frequent adverse effects of opioids in both populations at T1 and T2 were drowsiness (35% vs. 43%; 10% vs. 13%) and constipation (27% vs. 38%; 7% vs. 20%). Opioids remain the most widely used pain management strategy in neurotrauma. Promoting a judicious use of opioids, combined with other strategies, could help patients with neurotrauma achieve adequate and safe pain relief.
疼痛很常见，是创伤性脑损伤（TBI）和脊髓损伤（SCI）后导致残疾的主要原因。为了减轻神经创伤患者的疼痛负担，本研究旨在描述疼痛管理策略的使用情况以及阿片类药物在TBI和SCI患者中的不良反应。我们在患者出院时（T1）和受伤后3个月（T2）收集数据。总共纳入了70例患者，其中49例为TBI患者，21例为SCI患者，平均年龄为56岁（TBI组±21.1岁，SCI组±17.9岁）。几乎三分之一的TBI患者（33%）和SCI患者（29%）在T1时平均疼痛强度为中度，而大多数患者在T2时平均疼痛强度为轻度。在T1时，80%的患者使用阿片类药物，而在T2时，TBI患者中有26%、SCI患者中有53%使用阿片类药物。主要的辅助镇痛药是对乙酰氨基酚，TBI患者在T1和T2时使用的比例分别为78%和17%，SCI患者在T1和T2时使用的比例分别为81%和40%。TBI患者最常见的非药物策略在T1时是休息（45%），在T2时是休息（32%）；SCI患者在两个时间点最常见的非药物策略都是舒适体位（T1时81%，T2时53%）。在T1和T2时，这两类患者中阿片类药物最常见的两种不良反应都是嗜睡（分别为35%对43%；10%对13%）和便秘（分别为27%对38%；7%对20%）。阿片类药物仍然是神经创伤中使用最广泛的疼痛管理策略。推广合理使用阿片类药物并结合其他策略，可能有助于神经创伤患者实现充分且安全的疼痛缓解。
