PDF(Pubmed)
Abstract：
The prevalence of neuropathic pain (NP) in burn patients is reported in the literature to be as high as 80%1. Given the complexity of NP in burn patients and the wide range of treatments available, a systematic review of the literature is warranted to summarize our current understanding of management and treatment of NP in this population.
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The following databases were queried to identify relevant articles: PubMed, Cochrane, Embase, Scopus, Ovid, and Web of Science. The main outcome measures were incidence and management of NP. Secondary outcomes included risk factors for NP.
Included articles presented findings from 11 different countries, capturing outcomes for 4366 patients. Risk factors for neuropathic pain in burn patients were identified, including older age, alcohol and substance abuse, current daily smoking, greater % total body surface area burns (TBSA), and longer hospitalizations. Pharmacologic treatments included gabapentin/pregabalin (n = 7), ascorbic acid (n = 1), and lidocaine (n = 1). Overall, the studies showed varied results regarding the efficacy of pharmacological treatments. While certain studies demonstrated gabapentanoids to be effective in reducing neuropathic symptoms, others found conflicting results. With regards to non-pharmacologic treatments, electroconvulsive therapy (n = 1), electropuncture (n = 1), nerve release/reconstruction (n = 2), and somatosensory feedback rehabilitation (n = 1) were used and demonstrated promise in reducing pain intensity and improving functionality.
Despite NP afflicting the majority of burn patients long after their injury, this systematic review demonstrates insufficient evidence on the pathophysiology, outcomes, and risk factors in NP, as well as the efficacy of various therapies. Future prospective and randomized studies evaluating the etiology of these factors can substantially improve our treatment strategies. This can allow for the development of well-delineated and evidence-based protocols in NP management in hopes of improving quality of life and both psychological and physical function in burn patients.
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The following databases were queried to identify relevant articles: PubMed, Cochrane, Embase, Scopus, Ovid, and Web of Science. The main outcome measures were incidence and management of NP. Secondary outcomes included risk factors for NP.
Included articles presented findings from 11 different countries, capturing outcomes for 4366 patients. Risk factors for neuropathic pain in burn patients were identified, including older age, alcohol and substance abuse, current daily smoking, greater % total body surface area burns (TBSA), and longer hospitalizations. Pharmacologic treatments included gabapentin/pregabalin (n = 7), ascorbic acid (n = 1), and lidocaine (n = 1). Overall, the studies showed varied results regarding the efficacy of pharmacological treatments. While certain studies demonstrated gabapentanoids to be effective in reducing neuropathic symptoms, others found conflicting results. With regards to non-pharmacologic treatments, electroconvulsive therapy (n = 1), electropuncture (n = 1), nerve release/reconstruction (n = 2), and somatosensory feedback rehabilitation (n = 1) were used and demonstrated promise in reducing pain intensity and improving functionality.
Despite NP afflicting the majority of burn patients long after their injury, this systematic review demonstrates insufficient evidence on the pathophysiology, outcomes, and risk factors in NP, as well as the efficacy of various therapies. Future prospective and randomized studies evaluating the etiology of these factors can substantially improve our treatment strategies. This can allow for the development of well-delineated and evidence-based protocols in NP management in hopes of improving quality of life and both psychological and physical function in burn patients.
摘要：
背景：据文献报道，烧伤患者中神经性疼痛（NP）的患病率高达80％1。鉴于NP在烧伤患者中的复杂性和广泛的治疗方法，有必要对文献进行系统回顾,以总结我们目前对这一人群NP管理和治疗的理解.
方法：本系统评价是根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行的。查询了以下数据库以识别相关文章：PubMed，科克伦,Embase,Scopus,奥维德,和WebofScience。主要结局指标是NP的发生率和管理。次要结果包括NP的危险因素。
结果：包括来自11个不同国家的研究结果，获取4366例患者的结果。确定了烧伤患者神经性疼痛的危险因素，包括年龄较大,酒精和药物滥用，目前每天吸烟，总身体表面积烧伤(TBSA)住院时间更长。药物治疗包括加巴喷丁/普瑞巴林（n=7），抗坏血酸（n=1），和利多卡因（n=1）。总的来说,研究显示了关于药物治疗效果的不同结果。虽然某些研究表明加巴芬太尼可有效减轻神经性症状，其他人发现了相互矛盾的结果。关于非药物治疗，电惊厥治疗（n=1），电穿刺（n=1），神经释放/重建（n=2），和体感反馈康复（n=1）被使用，并证明在减轻疼痛强度和改善功能方面有希望。
结论：尽管NP使大多数烧伤患者在受伤后很长时间受到影响，本系统综述显示病理生理学证据不足，结果，和NP中的风险因素，以及各种疗法的疗效。未来评估这些因素病因的前瞻性和随机研究可以大大改善我们的治疗策略。这可以在NP管理中开发出轮廓清晰且基于证据的协议，以期改善烧伤患者的生活质量以及心理和身体功能。
方法：本系统评价是根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行的。查询了以下数据库以识别相关文章：PubMed，科克伦,Embase,Scopus,奥维德,和WebofScience。主要结局指标是NP的发生率和管理。次要结果包括NP的危险因素。
结果：包括来自11个不同国家的研究结果，获取4366例患者的结果。确定了烧伤患者神经性疼痛的危险因素，包括年龄较大,酒精和药物滥用，目前每天吸烟，总身体表面积烧伤(TBSA)住院时间更长。药物治疗包括加巴喷丁/普瑞巴林（n=7），抗坏血酸（n=1），和利多卡因（n=1）。总的来说,研究显示了关于药物治疗效果的不同结果。虽然某些研究表明加巴芬太尼可有效减轻神经性症状，其他人发现了相互矛盾的结果。关于非药物治疗，电惊厥治疗（n=1），电穿刺（n=1），神经释放/重建（n=2），和体感反馈康复（n=1）被使用，并证明在减轻疼痛强度和改善功能方面有希望。
结论：尽管NP使大多数烧伤患者在受伤后很长时间受到影响，本系统综述显示病理生理学证据不足，结果，和NP中的风险因素，以及各种疗法的疗效。未来评估这些因素病因的前瞻性和随机研究可以大大改善我们的治疗策略。这可以在NP管理中开发出轮廓清晰且基于证据的协议，以期改善烧伤患者的生活质量以及心理和身体功能。
