Annals of physical and rehabilitation medicine
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Ann Phys Rehabil Med · Mar 2009
Practice GuidelineNeuropathic pain in spinal cord injury: identification, classification, evaluation.
Chronic pain is very frequent after spinal cord injury, recent data showing that at least 80% of the patients experience pain, one-third at a severe level. The main objective of the present work is to report and discuss data regarding tools and procedures for the screening, diagnosis, and evaluation of neuropathic pain in spinal cord injury patients. ⋯ The DN4 questionnaire can be used for the screening and identification of neuropathic pain in this population of patients, often suffering from various types of pain. The use of the Spinal Cord Injury Pain Task Force of the International Association of the Study of Pain classification (SCIP-IASP), although some limitations, is recommended since taking into account physiopathology, localisation, and nature of pain. Daily uses of Visual Analogic Scale (VAS) or Numeric Scale (NS) are an obvious need and that of the questionnaire Douleur de Saint-Antoine (QDSA) for global evaluation and more specifically of the Neuropathic Pain Symptom Inventory (NPSI) for neuropathic pain are highly recommended.
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Ann Phys Rehabil Med · Mar 2009
Practice GuidelineChronic neuropathic pain management in spinal cord injury patients. What is the efficacy of pharmacological treatments with a general mode of administration? (oral, transdermal, intravenous).
The pharmacological treatment of patients with spinal cord injury (SCI) pain remains challenging despite new available drugs. Such treatment should always be viewed in the context of global pain management in these patients. To date few clinical trials have been specifically devoted to this topic, and the implementation of treatments is generally based on results obtained in peripheral neuropathic pain. The aim of this review is to present evidence for efficacy and tolerability of pharmacological treatments in SCI pain and propose therapeutic recommendations. ⋯ Very few pharmacological studies have dealt specifically with neuropathic pain related to SCI. Large scale studies and trials comparing several active drugs are warranted in SCI pain.
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Conduct a literature review on the organization models for the chronic neuropathic pain management of spinal cord injury (SCI) patients. ⋯ Specific pain management centers or hospital units remain the benchmark place for chronic pain in SCI patients. PM&R physicians play a key role in the care management of chronic SCI pain. The partnership PM&R-Pain management center aims to provide the most efficient and coordinated care for SCI patient.
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Ann Phys Rehabil Med · Mar 2009
Practice GuidelineChronic neuropathic pain in spinal cord injury patients: what relevant additional clinical exams should be performed?
Study the indications and level of evidence of clinical exams that might be relevant in exploring the causes of neuropathic pain in spinal cord injury patients. ⋯ For the neuropathic pain of spinal cord injury patients' additional clinical exams should be used in the framework of an etiological diagnosis.
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Ann Phys Rehabil Med · Mar 2009
Chronic neuropathic pain in spinal cord injured patients: what is the effectiveness of surgical treatments excluding central neurostimulations?
Analyzing the literature and elaborating recommendations on the following topics: relevance of dorsal root entry zone (DREZ) lesions, surgical treatment for posttraumatic syringomyelia, other therapeutic approaches (peripheral nerve root pain, nerve trunk pain and Sign Posterior Cord [SCI] pain). ⋯ The literature review can define the relevance of surgical treatments on some types of SCI pain. However, the results of many articles are difficult to analyze, as they do not report clinical or follow-up data.