|本期目录/Table of Contents|

[1]李连栋,雪 原,周佳明,等.静脉注射甲强龙治疗中央型脊髓损伤急性神经痛的疗效[J].天津医科大学学报,2019,25(01):37-42.
 LI Lian-dong,XUE Yuan,Zhou Jia-ming,et al.The analgesic effect of intravenous methylprednisolone on acute neuropathic pain with allodynia due to central cord syndrome[J].Journal of Tianjin Medical University,2019,25(01):37-42.
点击复制

静脉注射甲强龙治疗中央型脊髓损伤急性神经痛的疗效(PDF)
分享到:

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:
25卷
期数:
2019年01期
页码:
37-42
栏目:
临床医学
出版日期:
2019-01-20

文章信息/Info

Title:
The analgesic effect of intravenous methylprednisolone on acute neuropathic pain with allodynia due to central cord syndrome
文章编号:
1006-8147(2019)01-0037-06
作者:
李连栋1雪 原1周佳明1孙 超2
(1.天津医科大学总医院骨科,天津 300052;2.天津医科大学代谢病医院骨科,天津 300070)
Author(s):
LI Lian-dong1XUE Yuan1Zhou Jia-ming1SUN Chao2
(1.Department of Orthopaedics Surgery,Tianjin Medical University,General Hospital,Tianjin 300052,China;2.Department of Orthopaedics Surgery,Tianjin Metabolic Diseases Hospital,Tianjin 300070,China)
关键词:
甲强龙中央型脊髓损伤神经痛痛觉超敏视觉模拟评分
Keywords:
methylprednisolonecentral Cord Syndromeneuropathic painallodyniavisual Analog Scale
分类号:
R744
DOI:
-
文献标志码:
A
摘要:
目的:回顾性分析静脉注射甲强龙(MP)治疗中央型脊髓损伤(CCS)急性神经痛的疗效和安全性。方法:选取天津医科大学总医院2016年7月-2017年11月患有急性神经痛、视觉模拟评分(VAS)≥6分的中央型脊髓损伤患者34例,所有患者均接受MP治疗1周,随访时间3个月。治疗前、治疗后和随访时均采用标准的VAS评分、痛觉超敏体表面积和生活质量调查问卷对治疗效果进行评估。结果:MP治疗后及治疗后3个月的随访,VAS评分、痛觉超敏体表面积和患者的生活质量均较治疗前明显改善(P<0.001),所有病例均未见疼痛复发。经MP治疗1周,自发性疼痛VAS评分(0.93±1.32)较治疗前(7.33±0.69)明显降低,第3月随访时,所有患者均实现显著性疼痛缓解(VAS≤2);同时,痛觉超敏VAS评分较治疗前显著性下降(8.18±0.64 vs 1.70±1.43,P<0.001),第3月随访时,患者实现显著性疼痛缓解(VAS≤2)的比例达到91.18%;痛觉超敏的体表面积在治疗后及治疗后第1月和第3月随访分别为(101.65±205.55)cm2,(82.99±189.67)cm2及(36.77±106.29)cm2,与治疗前(2 791.23±625.20)cm2相比均显著性降低(P<0.001)。麦吉尔疼痛问卷表(MPQSF)和欧洲五维健康量表(EQ-5D)评估结果显示患者经MP治疗后生活质量获得明显改善(P<0.001),在MP治疗过程中,共有4例(11.76%)患者出现轻度的不良反应,以头晕和恶心居多,表现为一过性,在治疗后3个月随访中,所有病例未见MP相关性不良反应。结论:静脉注射MP能够有效缓解CCS急性神经痛,阻止急性神经痛转变为难治性慢性神经痛,能够显著改善患者的生活质量。
Abstract:
Objective: To retrospectively demonstrate the effects and safety of intravenous methylprednisolone (MP) on acute neuropathic pain relief,and the quality of life (QoL) in central cord syndrome (CCS) patients. Methods:From July 2016 to November 2017,34 CCS patients who suffered from severe acute neuropathic pain with allodynia were treated by intravenous MP for up to one week. The entire follow-up period was three months.Patients were evaluated with standard measures of efficacy: neuropathic pain intensity,the area of allodynia,and the QoL at baseline,daily treatment and one month and three months after the end of MP treatment. Results:After one week of MP treatment,the mean spontaneous pain intensity visual analog scale (VAS) scores ± SD before changed from 7.33±0.69 to 0.93±1.32 (P <0.001),and the mean dynamic allodynia intensity VAS scores ± SD decreased significantly compared with the baseline (8.18±0.64 vs 1.70±1.43,P <0.001). At the end of the follow-up period (three months),the proportions of patients who achieved excellent spontaneous pain and allodynia relief (VAS ≤2) were 100% and 91.18%,respectively.The allodynic areas decreased from(2 791.23±625.20)cm2 to(101.65±205.55)cm2 at endpoint of MP treatment and to(82.99±189.67)cm2 at the first month of follow-up and to(36.77±106.29)cm2 at the end of the follow-up period (all P <0.001). Moreover,this study showed MP could significantly improve the QoL of patients based on McGill Pain Questionnaire Short Form(MPQSF) and EuroQol Five Dimensions Questionnaire (EQ-5D). Four patients (11.76%) during MP treatment experienced mild or moderate side effects. None of the patients manifested CCS-associated neuropathic pain recurrence and MP-associated side effects during follow-up. Conclusion: Intravenous MP could provide effective pain relief and improvement in the QoL and prevent the transition from acute neuropathic pain into a chronic neuropathic pain in CCS patients with acute neuropathic pain.

参考文献/References:


[1] Thompson C,Gonsalves J F,Welsh D. Hyperextension injury of the cervical spine with central cord syndrome[J]. Eur Spine J,2015, 24(1):195
[2] Brooks N P. Central Cord Syndrome[J]. Neurosurg Clin N Am,2017, 28(1):41
[3] Siddall P J,Taylor D A,McClelland J M,et al. Pain report and the relationship of pain to physical factors in the first 6 months following spinal cord injury[J]. Pain,1999,81(1/2):187
[4] Haller H,Leblhuber F,Trenkler J,et al. Treatment of chronic neuropathic pain after traumatic central cervical cord lesion with gabapentin[J]. J Neural Transm (Vienna),2003,110(9):977
[5] Malmberg A B,Chen C,Tonegawa S,et al. Preserved acute pain and reduced neuropathic pain in mice lacking PKCgamma[J]. Science,1997,278(5336):279
[6] Jensen T S,Finnerup N B. Allodynia and hyperalgesia in neuropathic pain: clinical manifestations and mechanisms[J]. Lancet Neurol,2014,13(9):924
[7] Finnerup N B,Attal N,Haroutounian S,et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis[J]. Lancet Neurol,2015,14(2):162
[8] Serpell M,Latymer M,Almas M,et al. Neuropathic pain responds better to increased doses of pregabalin: an in-depth analysis of flexible-dose clinical trials[J]. J Pain Res,2017,10:1769
[9] Vase L,Skyt I,Hall K T. Placebo,nocebo,and neuropathic pain[J]. Pain,2016,157(Suppl 1):S98
[10] Siddall P J,Middleton J W. Spinal cord injury-induced pain: mechanisms and treatments[J]. Pain Manag,2015,5(6):493
[11] Vranken J H,Hollmann M W,van der Vegt M H,et al. Duloxetine in patients with central neuropathic pain caused by spinal cord injury or stroke: a randomized,double-blind,placebo-controlled trial[J]. Pain,2011,152(2):267
[12] Finnerup N B,Sindrup S H,Bach F W,et al. Lamotrigine in spinal cord injury pain: a randomized controlled trial[J]. Pain,2002,96(3):375
[13] Finnerup N B,Biering-Sorensen F,Johannesen I L,et al. Intravenous lidocaine relieves spinal cord injury pain: a randomized controlled trial[J]. Anesthesiol,2005,102(5):1023
[14] 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]. Neurol,2006,67(10):1792
[15] Salinas F A,Lugo L H,Garcia H I. Efficacy of early treatment with carbamazepine in prevention of neuropathic pain in patients with spinal cord injury[J]. Am J Phys Med Rehabil,2012,91(12):1020
[16] Voscopoulos C,Lema M. When does acute pain become chronic[J]. Br J Anaesth,2010,105( Suppl 1):i69
[17] Schneiderhan J,Clauw D,Schwenk TL. Primary Care of Patients With Chronic Pain[J]. Jama,2017,317(23):2367
[18] Lee S,Zhao X,Hatch M,et al. Central Neuropathic Pain in Spinal Cord Injury[J]. Crit Rev Phys Rehabil Med,2013,25(3-4):159
[19] Takeda K,Sawamura S,Sekiyama H,et al. Effect of methylprednisolone on neuropathic pain and spinal glial activation in rats[J]. Anesthesiol,2004,100(5):1249
[20] Kotani N,Kushikata T,Hashimoto H,et al. Intrathecal methylprednisolone for intractable postherpetic neuralgia[J]. N Engl J Med,2000,343(21):1514
[21] Calderon E,Calderon-Seoane M E,Garcia-Hernandez R,et al. 5% Lidocaine-medicated plaster for the treatment of chronic peripheral neuropathic pain: complex regional pain syndrome and other neuropathic conditions[J]. J Pain Res,2016,9:763
[22] Haanpaa M L,Backonja M M,Bennett M I,et al. Assessment of neuropathic pain in primary care[J]. Am J Med,2009,122(10 Suppl):S13
[23] Deseure K,Hans G H. Differential drug effects on spontaneous and evoked pain behavior in a model of trigeminal neuropathic pain[J]. J Pain Res,2017,10:279
[24] Karst M,Salim K,Burstein S,et al. Analgesic effect of the synthetic cannabinoid CT-3 on chronic neuropathic pain: a randomized controlled trial[J]. Jama,2003,290(13):1757
[25] Goldberg H,Mibielli M A,Nunes C P,et al. A double-blind,randomized,comparative study of the use of a combination of uridine triphosphate trisodium,cytidine monophosphate disodium,and hydroxocobalamin,versus isolated treatment with hydroxocobalamin,in patients presenting with compressive neuralgias[J]. J Pain Res,2017,10:397
[26] Attal N,Guirimand F,Brasseur L,et al. Effects of IV morphine in central pain: a randomized placebo-controlled study[J]. Neurol,2002,58(4):554
[27] Dong D S,Yu X,Wan C F,et al. Efficacy of Short-Term Spinal Cord Stimulation in Acute/Subacute Zoster-Related Pain: A Retrospective Study[J]. Pain Physician,2017,20(5):E633
[28] Rullan M,Bulilete O,Leiva A,et al. Efficacy of gabapentin for prevention of postherpetic neuralgia: study protocol for a randomized controlled clinical trial[J]. Trials,2017,18(1):24
[29] Nurmikko T J,Serpell M G,Hoggart B,et al. Sativex successfully treats neuropathic pain characterised by allodynia: a randomised,double-blind,placebo-controlled clinical trial[J]. Pain,2007,133(1-3):210
[30] Wallace M S,Magnuson S,Ridgeway B. Efficacy of oral mexiletine for neuropathic pain with allodynia: a double-blind,placebo-controlled,crossover study[J]. Reg Anesth Pain Med,2000,25(5):459
[31] Yucel A,Ozyalcin S,Koknel Talu G,et al. The effect of venlafaxine on ongoing and experimentally induced pain in neuropathic pain patients: a double blind,placebo controlled study[J]. Eur J Pain,2005,9(4):407
[32] Vigneri S,Sindaco G,La Grua M,et al. Combined epidural morphine and bupivacaine in the treatment of lumbosacral radicular neuropathic pain: a noncontrolled prospective study[J]. J Pain Res,2016,9:1081
[33] Gilron I,Bailey J M,Tu D,et al. Morphine,gabapentin,or their combination for neuropathic pain[J]. N Engl J Med,2005,352(13):1324
[34] Bracken M B,Shepard M J,Holford T R,et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study[J]. Jama,1997,277(20):1597
[35] Munts A G,van der Plas A A,Ferrari M D,et al. Efficacy and safety of a single intrathecal methylprednisolone bolus in chronic complex regional pain syndrome[J]. Eur J Pain,2010,14(5):523
[36] Fandel T M,Trivedi A,Nicholas C R,et al. Transplanted Human Stem Cell-Derived Interneuron Precursors Mitigate Mouse Bladder Dysfunction and Central Neuropathic Pain after Spinal Cord Injury[J]. Cell Stem Cell,2016,19(4):544
[37] Widerstrom-Noga E. Neuropathic Pain and Spinal Cord Injury: Phenotypes and Pharmacological Management[J]. Drugs,2017,77(9):967
[38] Sadosky A,Parsons B,Emir B,et al. Pain relief and functional improvement in patients with neuropathic pain associated with spinal cord injury: an exploratory analysis of pregabalin clinical trials[J]. J Pain Res,2016,9:405
[39] Nees T A,Finnerup N B,Blesch A,et al. Neuropathic pain after spinal cord injury: the impact of sensorimotor activity[J]. Pain,2017, 158(3):371
[40] Serpell M G. Gabapentin in neuropathic pain syndromes: a randomised,double-blind,placebo-controlled trial[J]. Pain,2002,99(3):557
[41] Rigo F K,Trevisan G,Godoy M C,et al. Management of Neuropathic Chronic Pain with Methadone Combined with Ketamine: A Randomized,Double Blind,Active-Controlled Clinical Trial[J]. Pain Physician,2017,20(3):207

相似文献/References:

备注/Memo

备注/Memo:
基金项目 国家自然科学基金资助项目(81471403)
作者简介 李连栋(1990-),男,硕士在读,研究方向:颈胸椎、肩关节外科及成骨信号系统;通信作者:雪原,E-mail:xueyuanzyy@163.com。
更新日期/Last Update: 2019-03-01