Biopsychosocial characteristics of patients with neuropathic pain following spinal cord trauma injury. Case reports

ABSTRACT BACKGROUND AND OBJECTIVES: Spinal cord injury is a change in spinal canal structures and may induce motor, sensory, autonomic and psychoaffective changes. Trauma injury is the most prevalent. Neuropathic pain is more frequent in people with spinal cord injury and may be disabling. Pain development mechanism is poorly known being its management difficult for both patients and health professionals. This study aimed at identifying biopsychosocial characteristics associated to neuropathic pain in spinal cord trauma injury patients. CASE REPORTS: Sample was made up of 13 patients with spinal cord trauma injury and neuropathic pain, hospitalized for rehabilitation in a health institution. The following data collection tools were used: Douleur Neuropathique em 4 Questions Questionnaire and Brief Pain Inventory, in addition to demographic data. Most patients were male, mean age of 40 years, retired or unemployed. Most frequent cause of spinal cord injury was car accident, followed by firearm and falls. The thoracic segment was more commonly affected, with prevalence of incomplete injuries. Neuropathic pain onset was predominantly within six months after spinal cord injury. Pharmacological treatment was the most cited and considered very effective by 70% of those who use it. Cold and immobility were the most common factors worsening pain; physical activity and leisure were factors improving pain. Mood and general activities were those influenced the most by neuropathic pain. CONCLUSION: Spinal cord trauma injury dramatically changes patients’ lives, generating disastrous consequences for those suffering the injury, their families and for society. In this series, most patients were young males, victims of car accidents and with neuropathic pain negatively impacting mood and general activities.摘要 背景与目的：脊髓损伤（spinal cord injury）指椎管结构发生病理性改变，可引发运动、感觉、自主神经及精神情感功能障碍，其中创伤性损伤为最常见类型。脊髓损伤患者的神经病理性疼痛（neuropathic pain）发生率更高，且可能导致致残性后果。目前疼痛发生的具体机制尚未明确，这使得患者与医护人员均难以对其进行有效管理。本研究旨在明确创伤性脊髓损伤患者中与神经病理性疼痛相关的生物-心理-社会特征。 病例报告：本研究纳入13例因创伤性脊髓损伤伴发神经病理性疼痛、于某医疗机构接受康复住院治疗的患者作为研究队列。研究采用以下数据采集工具：Douleur Neuropathique 4 Questions问卷（Douleur Neuropathique 4 Questions Questionnaire）以及简明疼痛评估量表（Brief Pain Inventory），同时收集人口学资料。本次研究对象多为男性，平均年龄40岁，多为退休或无业人员。脊髓损伤最常见的诱因为车祸，其次为枪支致伤与坠落伤。胸段脊髓为最常受累的节段，不完全性损伤占比更高。神经病理性疼痛多在脊髓损伤后6个月内起病。药物治疗为最常用的干预方式，70%的使用者认为该治疗效果极佳。寒冷与肢体制动是最常见的疼痛加重诱因，而体育活动与休闲活动则可缓解疼痛。神经病理性疼痛对情绪与日常活动影响最为显著。 结论：创伤性脊髓损伤会极大地改变患者的生活，为患者本人、其家属乃至社会均带来灾难性后果。本研究队列中，多数患者为年轻男性，因车祸致伤，且神经病理性疼痛会对其情绪与日常活动产生负面影响。