社区居住脊髓损伤患者慢性疼痛的4年回顾性研究
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摘要
目的回顾性分析社区居住的脊髓损伤患者疼痛现况。方法收集绵竹市人民医院康复科2015年至2018年的国际脊髓损伤疼痛数据集进行分析总结。结果 2015年至2018年间连续随访的脊髓损伤患者共19例,所有患者(100%)主诉均有疼痛,视觉模拟评分(VAS)(5.91±0.43)分,中度及以上疼痛者占94.7%(18/19);84.2%(16/19)患者曾经同时经历过肌肉骨骼疼痛和神经性疼痛。84.2%(16/19)患者的疼痛对日常生活等存在中度以上的干扰;68.4%(13/19)患者曾经接受过疼痛相关的治疗,治疗多为非甾体抗炎药和理疗,但其中61.5%(8/13)仅在一次调查中接受治疗。结论大部分社区脊髓损伤患者会经历中度以上多种类型的慢性疼痛;疼痛对大多数脊髓损伤患者日常生活存在中度以上干扰;绝大多数时候,脊髓损伤患者慢性疼痛未得到治疗;脊髓损伤患者慢性疼痛管理需要多学科参与。
Objective To retrospectively analyze the overall status of chronic pain in patients with spinal cord injury living in the community.Methods From 2015 to 2018, the spinal cord injury patients from rehabilitation department, hospital of Mianzhu City were enrolled; the International Spinal Cord Injury Pain Data Sets were analyzed and summarized.Results All 19 patients with spinal cord injury were followed up continuously. All patients(100%) complained of pain.The average Visual Analogue Score was(5.91±0.43), and the patients with moderate pain and above accounted for 94.7%(18/19); 84.2%(16/19) patients experienced both musculoskeletal pain and neuropathic pain at the same time. Daily life, mood and sleep etc. of 84.2%(16/19) patients were moderately or severely disturbed by pain. 68.4%(13/19) patients were treated for pain, mostly regards non-steroidal antiinflammatory drugs and physiotherapy, but 61.5%(8/13) were treated in only one survey.Conclusion Most patients with spinal cord injury in community experience moderate and above chronic pain with multiple types, which moderately or severely disturbs daily life of most of them. They do not access enough management for pain. Chronic pain management requires multidisciplinary participation.
Objective To retrospectively analyze the overall status of chronic pain in patients with spinal cord injury living in the community.Methods From 2015 to 2018, the spinal cord injury patients from rehabilitation department, hospital of Mianzhu City were enrolled; the International Spinal Cord Injury Pain Data Sets were analyzed and summarized.Results All 19 patients with spinal cord injury were followed up continuously. All patients(100%) complained of pain.The average Visual Analogue Score was(5.91±0.43), and the patients with moderate pain and above accounted for 94.7%(18/19); 84.2%(16/19) patients experienced both musculoskeletal pain and neuropathic pain at the same time. Daily life, mood and sleep etc. of 84.2%(16/19) patients were moderately or severely disturbed by pain. 68.4%(13/19) patients were treated for pain, mostly regards non-steroidal antiinflammatory drugs and physiotherapy, but 61.5%(8/13) were treated in only one survey.Conclusion Most patients with spinal cord injury in community experience moderate and above chronic pain with multiple types, which moderately or severely disturbs daily life of most of them. They do not access enough management for pain. Chronic pain management requires multidisciplinary participation.
引文
[1] Aulino M. Spinal cord injury pain[J]. Phys Med Rehabil Clin N Am, 2014, 25(2):397-410.
[2] Finnerup N B. Pain in patients with spinal cord injury[J]. Pain,2013, 154(1):71-76.
[3] Widerstr?m-Noga E, Anderson K D, Perez S, et al. Subgroup perspectives on chronic pain and its management after spinal cord injury[J]. J Pain, 2018, 19(12):1480-1490.
[4]刘根林,周红俊,李建军,等.脊髓损伤的诊断与康复[J].中国康复理论与实践, 2008, 14(7):610-613.
[5]美国脊髓损伤协会,国际脊髓损伤学会.脊髓损伤神经学分类国际标准(2011年修订)[J].李建军,王方永,译.中国康复理论与实践, 2011, 17(10):963-971.
[6]康海琼,周红俊,李建军,等.国际脊髓损伤数据集:疼痛基础数据集[J].中国康复理论与实践, 2010, 16(1):72-82.
[7] Dijkers M, Bryce T, Zanca J. Prevalence of chronic pain after traumatic spinal cord injury:a systematic review[J]. Rehabil R D, 2009, 46(1):13-29.
[8] Ballinger D A, Rintala D H, Hart K A. The relation of shoulder pain and range-of-motion problems to functional limitations,disability, and perceived health of men with spinal cord injury:a multifaceted longitudinal study[J]. Arch Phys Med Rehabil,2000, 81(12):1575-1581.
[9] Finnerup N B, Norrbrink C, Trok K, et al. Phenotypes and predictors of pain following traumatic spinal cord injury:a prospective study[J]. Pain, 2014, 15(1):40-48.
[10] Cruz-Almeida Y, Martinez-Arizala A, Widerstr?m-Noga E G.Chronicity of pain associated with spinal cord injury:a longitudinal analysis[J]. J Rehabil Res Dev, 2005, 42(5):585-594.
[11]邹军,徐瑞生.颈髓损伤后慢性疼痛流行病学调查[J].交通医学, 2013, 27(6):630-631, 633.
[12]温华聪.四川地震脊髓损伤伤员慢性疼痛研究[D].南京:南京医科大学, 2014:1-55.
[13]刘芳.脊髓损伤后疼痛相关因素分析[D].北京:首都医科大学, 2012:1-60.
[14] Hanley M A, Jensen M P, Ehde D M, et al. Clinically significant change in pain intensity ratings in persons with spinal cord injury or amputation[J]. Clin J Pain, 2006, 22(1):25-31.
[15] Siddall P J, Loeser J D. Pain following spinal cord injury[J].Spinal Cord, 2001, 39(2):63-73.
[16]赵红霞,张继荣.脊髓损伤后疼痛分类的探讨[J].中国康复, 2015, 30(3):225-228.
[17]张磊,贺石生.脊髓损伤后疼痛评估系统的使用及选择比较[J].中国康复医学杂志, 2014, 29(4):360-363.
[18] Budh C N, Lund I, Ertzgaard P, et al. Pain in a Swedish spinal cord injury population[J]. Clin Rehabil, 2003, 17(6):685-690.
[19] Werhagen L, Budh C N, Hultling C, et al. Neuropathic pain after traumatic spinal cord injury:relations to gender, spinal level, completeness, and age at the time of injury[J]. Spinal Cord, 2004, 42(12):665-673.
[20] Siddall P J, McClelland J M, Rutkowski S B, et al. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury[J]. Pain, 2003, 103(3):249-257.
[21] Finnerup N B, Faaborg P, Krogh K, et al. Abdominal pain in long-term spinal cord injury[J]. Spinal Cord, 2008, 46(3):198-203.
[22] Wollaars M M, Post M W M, van Asbeck F W A, et al. Spinal cord injury pain:the influence of psychologic factors and impact on quality of life[J]. Clin J Pain, 2017, 23(5):383-391.
[23] Andresen S R, Biering-Sorensen F, Hagen E M, et al. Pain,spasticity and quality of life in individuals with traumatic spinal cord injury in Denmark[J]. Spinal Cord, 2016, 54(11):973-979.
[24] Widerstrom-Noga E, Anderson K D, Perez S, et al. Living with chronic pain after spinal cord injury:a mixed-methods study[J]. Arch Phys Med Rehabil, 2017, 98(5):856-865.
[25] Rintala D H, Holmes S A, Courtade D, et al. Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury[J]. Arch Phys Med Rehabil, 2007, 88(12):1547-1560.
[26] Levendoglu F, Ogun C O, Ozerbil O, et al. Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury[J]. Spine, 2004, 29(7):743-751.
[27]郭艳萍,赵金荣,韩芳,等.加巴喷丁联合阿米替林治疗脊髓损伤后中枢性疼痛的临床观察[J].中国疼痛医学杂志, 2015,21(5):397-398.
[28] Siddall P J, Cousins M J, Otte A, et al. Pregabalin in central neuropathic pain associated with spinal cord injury:a placebo controlled trial[J]. Neurology, 2006, 67(10):1792-1800.
[29]栗晓,柯松坚,罗海杰,等.普瑞巴林联合神经妥乐平治疗脊髓损伤患者神经病理性疼痛的疗效观察[J].中国康复医学杂志, 2017, 32(7):783-787.
[30] Norrbrink C, Lundeberg T. Tramadol in neuropathic pain after spinal cord injury:a randomized, double-blind, placebo-controlled trial[J]. Clin J Pain, 2009, 25(3):177-184.
[31] Mehta S, Teasell R W, Loh E, et al. Pain following spinal cord injury. Spinal cord injury rehabilitation evidence[EB/OL].(2018-8-31). https://scireproject. com/evidence/rehabilitationevidence/pain-management/.
[32] Putzke J D, Richards J S, Kezar L, et al. Long-term use of gabapentin for treatment of pain after traumatic spinal cord injury[J]. Clin J Pain, 2002, 18(2):116-121.
[33]刘曦,王剑雄,李涛,等.重复经颅磁刺激治疗脊髓损伤后慢性神经病理性疼痛8例报道[J].中国康复理论与实践, 2017,23(7):829-832.
[34]吴勤峰,施加加,李向哲,等.重复经颅磁刺激治疗外伤性脊髓损伤后神经病理性疼痛的疗效观察[J].中国康复医学杂志, 2018, 33(3):333-336.
[35] Boldt I, Eriks-Hoogland I, Brinkhof M W, et al. Non-pharmacological interventions for chronic pain in people with spinal cord injury[J]. Cochrane Database Syst Rev, 2014, 28(11):CD009177.
[36] NIH Consensus Conference. Acupuncture[J]. JAMA, 1998,280(17):1518-1524.
[37]李小宏,谢德娟,余和平.综合疗法治疗脊髓损伤后中枢性疼痛32例临床观察[J].中国康复理论与实践, 2009, 15(2):112-113.
[38] Seal K, Becker W, Tighe J, et al. Managing chronic pain in primary care:it really does take a village[J]. J J Gen Intern Med, 2017, 32(8):931-934.
[39] Hearn J H, Cotter I, Fine P, et al. Living with chronic neuropathic pain after spinal cord injury:an interpretative phenomenological analysis of community experience[J]. Disabil Rehabil, 2015, 37(23):2203-2211.
[40] Shin J C, Kim N Y, Chang S H, et al. Effect of patient education on reducing medication in spinal cord injury patients with neuropathic pain[J]. Ann Rehabil Med, 2017, 41(4):621-630.
[41] Burns A S, Delparte J J, Ballantyne E C, et al. Evaluation of an interdisciplinary program for chronic pain after spinal cord injury[J]. PM R, 2013, 5(10):832-838.
[42] Buscemi V, Cassidy E, Kilbride C, et al. A qualitative exploration of living with chronic neuropathic pain after spinal cord injury:an Italian perspective[J]. Disabil Rehabil, 2017, 40(5):577-586.
[43] Norrbrink C, L?fgren M. Needs and requests:patients and physicians voices about improving the management of spinal cord injury neuropathic pain[J]. Disabil Rehabil, 2016, 38(2):151-158.
[2] Finnerup N B. Pain in patients with spinal cord injury[J]. Pain,2013, 154(1):71-76.
[3] Widerstr?m-Noga E, Anderson K D, Perez S, et al. Subgroup perspectives on chronic pain and its management after spinal cord injury[J]. J Pain, 2018, 19(12):1480-1490.
[4]刘根林,周红俊,李建军,等.脊髓损伤的诊断与康复[J].中国康复理论与实践, 2008, 14(7):610-613.
[5]美国脊髓损伤协会,国际脊髓损伤学会.脊髓损伤神经学分类国际标准(2011年修订)[J].李建军,王方永,译.中国康复理论与实践, 2011, 17(10):963-971.
[6]康海琼,周红俊,李建军,等.国际脊髓损伤数据集:疼痛基础数据集[J].中国康复理论与实践, 2010, 16(1):72-82.
[7] Dijkers M, Bryce T, Zanca J. Prevalence of chronic pain after traumatic spinal cord injury:a systematic review[J]. Rehabil R D, 2009, 46(1):13-29.
[8] Ballinger D A, Rintala D H, Hart K A. The relation of shoulder pain and range-of-motion problems to functional limitations,disability, and perceived health of men with spinal cord injury:a multifaceted longitudinal study[J]. Arch Phys Med Rehabil,2000, 81(12):1575-1581.
[9] Finnerup N B, Norrbrink C, Trok K, et al. Phenotypes and predictors of pain following traumatic spinal cord injury:a prospective study[J]. Pain, 2014, 15(1):40-48.
[10] Cruz-Almeida Y, Martinez-Arizala A, Widerstr?m-Noga E G.Chronicity of pain associated with spinal cord injury:a longitudinal analysis[J]. J Rehabil Res Dev, 2005, 42(5):585-594.
[11]邹军,徐瑞生.颈髓损伤后慢性疼痛流行病学调查[J].交通医学, 2013, 27(6):630-631, 633.
[12]温华聪.四川地震脊髓损伤伤员慢性疼痛研究[D].南京:南京医科大学, 2014:1-55.
[13]刘芳.脊髓损伤后疼痛相关因素分析[D].北京:首都医科大学, 2012:1-60.
[14] Hanley M A, Jensen M P, Ehde D M, et al. Clinically significant change in pain intensity ratings in persons with spinal cord injury or amputation[J]. Clin J Pain, 2006, 22(1):25-31.
[15] Siddall P J, Loeser J D. Pain following spinal cord injury[J].Spinal Cord, 2001, 39(2):63-73.
[16]赵红霞,张继荣.脊髓损伤后疼痛分类的探讨[J].中国康复, 2015, 30(3):225-228.
[17]张磊,贺石生.脊髓损伤后疼痛评估系统的使用及选择比较[J].中国康复医学杂志, 2014, 29(4):360-363.
[18] Budh C N, Lund I, Ertzgaard P, et al. Pain in a Swedish spinal cord injury population[J]. Clin Rehabil, 2003, 17(6):685-690.
[19] Werhagen L, Budh C N, Hultling C, et al. Neuropathic pain after traumatic spinal cord injury:relations to gender, spinal level, completeness, and age at the time of injury[J]. Spinal Cord, 2004, 42(12):665-673.
[20] Siddall P J, McClelland J M, Rutkowski S B, et al. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury[J]. Pain, 2003, 103(3):249-257.
[21] Finnerup N B, Faaborg P, Krogh K, et al. Abdominal pain in long-term spinal cord injury[J]. Spinal Cord, 2008, 46(3):198-203.
[22] Wollaars M M, Post M W M, van Asbeck F W A, et al. Spinal cord injury pain:the influence of psychologic factors and impact on quality of life[J]. Clin J Pain, 2017, 23(5):383-391.
[23] Andresen S R, Biering-Sorensen F, Hagen E M, et al. Pain,spasticity and quality of life in individuals with traumatic spinal cord injury in Denmark[J]. Spinal Cord, 2016, 54(11):973-979.
[24] Widerstrom-Noga E, Anderson K D, Perez S, et al. Living with chronic pain after spinal cord injury:a mixed-methods study[J]. Arch Phys Med Rehabil, 2017, 98(5):856-865.
[25] Rintala D H, Holmes S A, Courtade D, et al. Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury[J]. Arch Phys Med Rehabil, 2007, 88(12):1547-1560.
[26] Levendoglu F, Ogun C O, Ozerbil O, et al. Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury[J]. Spine, 2004, 29(7):743-751.
[27]郭艳萍,赵金荣,韩芳,等.加巴喷丁联合阿米替林治疗脊髓损伤后中枢性疼痛的临床观察[J].中国疼痛医学杂志, 2015,21(5):397-398.
[28] Siddall P J, Cousins M J, Otte A, et al. Pregabalin in central neuropathic pain associated with spinal cord injury:a placebo controlled trial[J]. Neurology, 2006, 67(10):1792-1800.
[29]栗晓,柯松坚,罗海杰,等.普瑞巴林联合神经妥乐平治疗脊髓损伤患者神经病理性疼痛的疗效观察[J].中国康复医学杂志, 2017, 32(7):783-787.
[30] Norrbrink C, Lundeberg T. Tramadol in neuropathic pain after spinal cord injury:a randomized, double-blind, placebo-controlled trial[J]. Clin J Pain, 2009, 25(3):177-184.
[31] Mehta S, Teasell R W, Loh E, et al. Pain following spinal cord injury. Spinal cord injury rehabilitation evidence[EB/OL].(2018-8-31). https://scireproject. com/evidence/rehabilitationevidence/pain-management/.
[32] Putzke J D, Richards J S, Kezar L, et al. Long-term use of gabapentin for treatment of pain after traumatic spinal cord injury[J]. Clin J Pain, 2002, 18(2):116-121.
[33]刘曦,王剑雄,李涛,等.重复经颅磁刺激治疗脊髓损伤后慢性神经病理性疼痛8例报道[J].中国康复理论与实践, 2017,23(7):829-832.
[34]吴勤峰,施加加,李向哲,等.重复经颅磁刺激治疗外伤性脊髓损伤后神经病理性疼痛的疗效观察[J].中国康复医学杂志, 2018, 33(3):333-336.
[35] Boldt I, Eriks-Hoogland I, Brinkhof M W, et al. Non-pharmacological interventions for chronic pain in people with spinal cord injury[J]. Cochrane Database Syst Rev, 2014, 28(11):CD009177.
[36] NIH Consensus Conference. Acupuncture[J]. JAMA, 1998,280(17):1518-1524.
[37]李小宏,谢德娟,余和平.综合疗法治疗脊髓损伤后中枢性疼痛32例临床观察[J].中国康复理论与实践, 2009, 15(2):112-113.
[38] Seal K, Becker W, Tighe J, et al. Managing chronic pain in primary care:it really does take a village[J]. J J Gen Intern Med, 2017, 32(8):931-934.
[39] Hearn J H, Cotter I, Fine P, et al. Living with chronic neuropathic pain after spinal cord injury:an interpretative phenomenological analysis of community experience[J]. Disabil Rehabil, 2015, 37(23):2203-2211.
[40] Shin J C, Kim N Y, Chang S H, et al. Effect of patient education on reducing medication in spinal cord injury patients with neuropathic pain[J]. Ann Rehabil Med, 2017, 41(4):621-630.
[41] Burns A S, Delparte J J, Ballantyne E C, et al. Evaluation of an interdisciplinary program for chronic pain after spinal cord injury[J]. PM R, 2013, 5(10):832-838.
[42] Buscemi V, Cassidy E, Kilbride C, et al. A qualitative exploration of living with chronic neuropathic pain after spinal cord injury:an Italian perspective[J]. Disabil Rehabil, 2017, 40(5):577-586.
[43] Norrbrink C, L?fgren M. Needs and requests:patients and physicians voices about improving the management of spinal cord injury neuropathic pain[J]. Disabil Rehabil, 2016, 38(2):151-158.