PDF(Pubmed)
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，因为它影响了80％的患者，这对他们的生活质量产生了负面影响。尽管在任何类型的疼痛（神经性，伤害性,混合)在这些患者中，没有治愈方法,和一些治疗的镇痛效果是不够的。本研究旨在对SCI后疼痛的各种干预措施进行循证系统评价。PubMed,物理治疗证据数据库（PEDro），从1969年到2023年搜索了Cochrane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，纳入本系统评价。在目前的不同干预措施中，18项研究检查了口服药物的作用，11项研究检查了微创方法（注射和输注）的作用，16项研究调查了物理治疗和替代疗法，和12项研究检查了重复经颅磁刺激（rTMS）的作用，经颅直流电刺激（tDCS），和颅脑电疗刺激（CES）在SCI患者疼痛管理中的应用。加巴喷丁和普瑞巴林在治疗SCI后的慢性神经性疼痛方面非常有效，普瑞巴林似乎还可以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,卡马西平没有镇痛作用，但是米罗加巴林是一种新颖而有前途的药物。抗抑郁药（选择性5-羟色胺再摄取抑制剂和5-羟色胺和去甲肾上腺素再摄取抑制剂）不能减轻患者的疼痛，尽管一些研究表明阿米替林特别是在抑郁症患者中的疗效，曲马多应该被视为短期谨慎。此外，tDCS和rTMS减轻疼痛。此外，A型肉毒杆菌毒素,利多卡因,氯胺酮,鞘内注射巴氯芬可显着降低疼痛强度，尽管研究的样本很小。物理治疗和替代疗法似乎可以缓解疼痛，经皮神经电刺激的疼痛强度降低最大。总之,存在几种药物和非药物方法，可以减轻SCI后患者的疼痛。干预的类型可以由医生根据患者的偏好来考虑，年龄,病史,类型的疼痛，和相关症状。然而,应该进行更多的研究，样本更大，方法学质量更好。
