脊髓损伤后疼痛的临床研究证据

王玉明，唐丽，李建军

脊髓损伤后疼痛的临床研究证据

王玉明1，唐丽2，李建军1

疼痛是脊髓损伤后常见并发症。有关临床研究涉及疼痛机制、分类及治疗等。由于脊髓损伤后疼痛需要综合性治疗，其中每一种干预措施可能都只产生很小的疗效。本文通过文献复习脊髓损伤后疼痛方面临床研究，审慎地应用最佳证据做出临床决策。

脊髓损伤；疼痛；康复；综述

[本文著录格式]王玉明，唐丽，李建军.脊髓损伤后疼痛的临床研究证据[J].中国康复理论与实践,2014,20(10):945-949.

最近几十年，脊髓损伤后膀胱、皮肤、心血管和呼吸系统护理等方面取得显著成效，但是脊髓损伤后疼痛仍然缺乏有效的治疗措施。目前脊髓损伤疼痛机制众说纷纭，而且缺乏标准的分类方法，这都将影响脊髓损伤后疼痛的治疗效果[1]。

1 发病率、性质及分类

疼痛是脊髓损伤常见并发症之一。各种文献所报道的脊髓损伤后疼痛发生率差异较大，为11%～94%[2]，最近报道多为60%～80%的脊髓损伤患者需要经历疼痛煎熬[3-4]。估计30%～40%的脊髓损伤患者患有严重的致残性疼痛[4-5]。四肢瘫患者、胸脊髓损伤患者与马尾神经病变者的重度疼痛发生率分别为10%～15%、25%和42%～51%[6]。Bonica研究发现疼痛在脊髓损伤患者中普遍存在，但异质性明显[5]。脊髓损伤后疼痛国际协会专家组最新提出了一种分类标准，将疼痛分为感受伤害(肌肉骨骼性和内脏性疼痛)和神经性疼痛(损伤水平以上、之中和以下的疼痛)[7]。Finnerup等研究发现神经痛随着时间逐渐加重，而肌肉骨骼性疼痛则相反，且损伤后1个月内出现感觉过敏预示着损伤平面以下疼痛的发展[8]。

2 心理因素

大多数慢性脊髓损伤疼痛研究主要集中在医学原因和临床表现。Woollaars问卷调查后发现脊髓损伤后疼痛发生率高达77%。与轻度疼痛相关的因素有疼痛控制和应对、淡然对待、高损伤水平和非外伤性脊髓损伤原因。高抑郁水平与脊髓损伤后无助感、“灾难化”和愤怒相关。令人惊讶的是疼痛强度与健康、幸福感、抑郁没有独立关系[9]。使用药物、手术治疗脊髓损伤后疼痛之前，应充分了解患者的心理社会环境[10-12]。Giardino指出根据“共同应对灾难化”模型，疼痛患者可向社会获得支持[13]。

3 脊髓损伤后疼痛的非药物管理

3.1 按摩

按摩主要用于治疗肌肉骨骼疼痛。Budh等对脊髓损伤3年病史的患者进行调查，发现按摩和热疗是最好的非药物治疗[14]。Heutink等通过问卷调查发现脊髓损伤患者常用按摩缓解疼痛并认为治疗效果较好[15]。Norrbrink等研究中发现针灸与按摩皆能缓解脊髓损伤后疼痛[16]。研究证实按摩可一定程度缓解脊髓损伤后疼痛。

3.2 整骨疗法

整骨疗法经证实对患者骨关节炎和炎症条件的慢性疼痛有效。整骨疗法缓解疼痛与它影响β-内啡肽释放和减少5-羟色胺相关[17]。Arienti等研究证实单独整骨疗法缓解脊髓损伤后疼痛效果有限[18]。

3.3 针刺疗法

针灸是中医的重要组成部分，可激活Ⅱ型和Ⅲ型肌肉传入神经纤维或A-δ纤维，通过刺激大感觉神经元以及释放内源性阿片类药物、神经递质和神经激素阻断疼痛闸门[19-20]。Lee等最近报道针灸通过抑制星形胶质细胞jun-氨基末端激酶激活缓解脊髓损伤后神经痛[21]。Dyson-Hudson等证实针刺及Trager治疗对减轻脊髓损伤患者功能活动性肩痛均有效[20,22]。Nayak等发现42%中枢性疼痛患者和80%肌肉骨骼疼痛患者疼痛得到了明显缓解[23]。Rapson等试验报道，67%患者疼痛改善，特别是双侧对称恒定的烧灼痛[24]。樊留博等发现针灸缓解脊髓损伤后疼痛效果显著[25]。因此，有证据证明针灸可缓解脊髓损伤后伤害性肌肉骨骼肩部疼痛及神经性疼痛。

3.4 运动疗法

运动可以改善慢性疾病，增强个人主观幸福感。Ditor证实肩胛骨训练特异地拉伸肩胛骨并加强肩袖肌肉，对减轻肩关节疼痛和改善功能都有效果[26]。Nash等报道中年截瘫患者经过4个月循环抗阻训练(CRT)后的肌力、耐力、无氧功率明显增强，而肩疼痛评分也明显降低(P=0.008)[27]。Finley等研究显示特殊轮椅(MAGICwheels)减少肩部疼痛[28]。

3.5 行为管理

3.5.1 催眠暗示

催眠用于治疗脊髓损伤后疼痛机制不明。催眠是非药物性、有潜力的治疗，鉴于催眠反应的可变性，目前对它的使用存在争议。Jensen等研究发现81%的脊髓损伤患者在损伤1年后仍使用催眠，但只有23%的患者疼痛强度缓解[29]，这些数据说明催眠也许不是直接缓解疼痛强度，而是减轻患者的疼痛体验。

3.5.2 认知行为疗法

认知行为疗法(CBT)是一种对慢性疼痛常用的心理干预，是全面疼痛管理计划的一部分。Norrbrink Budh等治疗脊髓损伤后疼痛患者的疼痛管理计划包括教育、行为疗法、放松疗法、运动和主体意识培养，研究发现这种管理计划并没有明显改变疼痛强度[30]。Perry等将脊髓损伤慢性疼痛患者置于多学科疼痛认知行为管理计划中，治疗组中出现改善疼痛强度和医院焦虑抑郁量表(HADS)评分下降的趋势。然而，9个月随访时分数恢复到治疗前[31]。有研究者认为行为认知疗法可能是通过控制脊髓损伤疼痛相关的心理症状帮助患者应对疼痛。

3.5.3 视觉意象

视觉意象疗法使用引导图像改变感知和行为，促进皮质重组从而缓解疼痛[32]，已在各种研究中应用[33-34]。Soler等发现视觉意象结合经颅直流电刺激(TDCS)可减少疼痛感知、缓解疼痛、改善工作能力和睡眠(P＜0.05)。结合组30%参与者疼痛强度改善30%以上。视觉意象组报道疼痛强度显著改善(P= 0.02)，然而效果维持不到12周[35]。视觉意象疗法对马尾神经损伤患者效果显著，因此应用视觉意象疗法时应考虑脊髓损伤类型[36]。

3.6 经颅电刺激

经颅电刺激(TCES)在头皮上应用电极施加电流，是脊髓损伤后疼痛一种相对较新的治疗方法。3个随机对照试验(Soler[35]、Tan[37]、Fregni[38])都表明它可能缓解脊髓损伤相关的慢性疼痛。但治疗参数，如刺激时间、治疗周期等未达成一致。

3.7 经颅磁刺激

经颅磁刺激(TMS)是一种非侵入性、相对安全的技术，线圈电磁流产生的脉冲磁场穿过颅骨诱导神经元去极化[39]。Defrin等[39]和Kang等[40]的两个随机试验提供1级证据：经颅磁刺激可降低痛阈，但不减轻疼痛强度。今后的研究应致力于参数研究，如刺激时间与强度。

3.8 经皮神经电刺激

经皮神经电刺激(TENS)常用于缓解疼痛，已被证明对慢性肌肉骨骼疼痛治疗有效[41]。TENS优先刺激大α感觉神经，在脊髓背角突触水平通过伤害性抑制来减少疼痛[42]。Norrbrink Budh等的交叉研究提供1级证据：TENS降低疼痛强度、重度疼痛强度、疼痛不适感。但高频率或低频率TENS在改善神经性疼痛方面没有显著差别[30]。

3.9 静态磁场

Panagos等应用静态磁场(SMF)治疗脊髓损伤后疼痛，发现0.05 T的静磁场磁体可缓解刺痛、锐痛、触疼痛(P＜0.05)；然而视觉模拟评分(VAS)没有显著变化[43]。此试验未设置对照组且样本量相对较少，仅提供有限的4级证据。

4 药物治疗

药物治疗脊髓损伤后疼痛是标准治疗。非药物治疗效果有局限，重度致残性疼痛往往需要增加药物干预处理。

4.1 抗惊厥药

抗癫痫药物用于治疗脊髓损伤后神经性疼痛或部分去传入性疼痛。加巴喷丁和普瑞巴林是神经性疼痛的一线用药[44]。2007年加拿大疼痛协会指南仅推荐卡马西平治疗原发性三叉神经痛有效，不推荐用于治疗其他神经病理性疼痛。Finnerup等报道拉莫三嗪对不完全脊髓损伤患者疼痛有治疗效果(2级证据)[45]。Finnerup等进行了随机双盲交叉试验，发现左乙拉西坦和安慰剂对改善疼痛强度无显著性差异(P=0.46)(1级证据)[46]。

4.2 三环类抗抑郁药

三环类抗抑郁药(TCA)通过在中枢神经系统中制造更多的血清素治疗抑郁来调节疼痛。Vranken等发现度洛西汀可显著改善疼痛[47]。对患有抑郁症的脊髓损伤患者，阿米替林优于苯海拉明(1级证据)[48]。

4.3 麻醉药物

Finnerup等报道多卡因静脉注射后短期减少疼痛(1级证据)[49]。Kvarnstrom等发现氯胺酮能成功减少脊髓损伤后神经性疼痛(1级证据)[50]。而慢心利不能改善脊髓损伤感觉触物感性疼痛(1级证据)[51]。

4.4 抗痉挛的药物

已证实巴氯芬可抑制触刺激诱发痛。Uchikawa等对7例有痉挛性肩关节疼痛的脊髓损伤患者进行运动点苯酚石碳酸阻滞注射，随访时明显有肩痛视觉模拟评分(VAS)改善(P＜0.05)[52]。Marciniak等应用A型肉毒毒素注射治疗29例患者的局灶性肌痉挛，疼痛改善83.3%[53]。

4.5 阿片类药物

由于存在药物成瘾及滥用，阿片类镇痛药治疗脊髓损伤后疼痛的研究相对较少。Barrera等发现结合抗惊厥治疗时，羟考酮明显降低脊髓损伤后疼痛强度并改善睡眠(4级证据)[54]。

4.6 大麻素

Wade等与Hagenbach等对减少脊髓损伤后痉挛性疼痛提供的证据相互矛盾[55-56]，可能是一种新的治疗，但需要进一步研究。Rintala等研究镇吐药屈大麻酚与苯海拉明对脊髓损伤后疼痛的治疗效果，发现两治疗组间疼痛强度差异不显著(1级证据)[57]。

4.7 可乐定

可乐定是一种α2肾上腺素能受体兴奋剂，通过激活在脊髓背角的α2肾上腺素能受体来抑制伤害感受冲动。Ackerman指出那些对阿片类药物无反应的患者可使用可乐定缓解疼痛[58]。

4.8 局部辣椒素

辣椒素是辣椒中的活性生物碱。它已成功地用于减少带状疱疹后神经痛、糖尿病神经病变神经痛与术后疼痛综合征[59]。作为P物质抑制剂，局部辣椒素可用来治疗脊髓损伤后1～2周的神经根性疼痛，且有长期效果(4级证据)[59]。

5 手术干预

5.1 脊髓电刺激

脊髓电刺激已被用来尝试治疗顽固性疼痛[60]，可用于改善脊髓损伤后疼痛。

5.2 背侧纵T形脊髓切开术

Livshits等发现Pourpre手术似乎比Bischof II缓解疼痛效果更明显[61]。

5.3 脊神经后根切断术

当患者下肢轻瘫且是单根局限疼痛，可考虑一个或两个水平脊神经后根切断术[62]。既往研究缺乏对照组及远期效果的监测，仍需进一步研究。

5.4 交感神经切除术

对脊髓损伤后疼痛患者不推荐交感神经切除术[63]。

5.5 全脊髓损毁术

赖光辉等对14例脊髓损伤后神经痛患者经过磁共振检查和体格检查确定损伤平面，在其上1～2个节段，应用CT引导定位经椎板穿刺至脊髓进行持续射频热凝治疗所有患者均毁损成功，除1例在治疗后3年疼痛复发进行二次脊髓毁损治疗后疼痛消失外，其余患者均无疼痛发生，其有效率为92.9%[64]。

6 总结

脊髓损伤后疼痛治疗方法多样，但疗效欠佳。有效联合应用以上治疗方法不仅能缓解脊髓损伤后疼痛，同时还能提高患者日常生活活动能力，减轻家庭和社会负担。

[1]Calmels P,Mick G,Perrouin-Verbe B,et al.Neuropathic pain in spinal cord injury:identifcation,classifcation,evaluation[J]. Ann Phys Rehabil Med,2009,52(2):83-102.

[2]Ehde DM,Jensen MP,Engel JM,et al.Chronic pain secondary to disability:a review[J].Clin J Pain,2003,19(1):3-17.

[3]Norrbrink Budh C,Lund I,Hultling C,et al.Gender related differences in pain in spinal cord injured individuals[J].Spinal Cord,2003,41(2):122-128.

[4]Cruz-AlmeidaY,Martinez-ArizalaA,Widerstrom-Noga EG. Chronicity of pain associated with spinal cord injury:A longitudinal analysis[J].J Rehabil Res Dev,2005,42(5):585-594.

[5]Bonica JJ.Introduction:Semantic,Epidemiologic and Educational Issues[M]//Casey K.Pain and Central Nervous System Disease:the Central Pain Syndromes.New York:Raven Press, 1991:13-29.

[6]Ragnarsson KT.Management of pain in persons with spinal cord injury[J].Spinal Cord Med,1997,20(2):186-199.

[7]Bryce TN,Biering-Sorensen F,Finnerup NB,et al.International spinal cord injury pain classification:part I.Background and description.March 6-7,2009[J].Spinal Cord,2012,50(6): 413-417.

[8]Finnerup NB,Norrbrink C,Trok K,et al.Phenotypes and predictors of pain following traumatic spinal cord injury:a prospective study[J].J Pain,2014,15(1):40-48.

[9]Wollaars MM,Post MW,van Asbeck FW,et al.Spinal cord injury pain:the influence of psychologic factors and impact on quality of life[J].Clin J Pain,2007,23(5):383-391.

[10]Jensen MP,Moore MR,Bockow TB,et al.Psychosocial factors and adjustment to chronic pain in persons with physical disabilities:A systematic review[J].Arch Phys Med Rehabil, 2011,92(1):146-160.

[11]Kratz AL,Hirsh AT,Ehde DM,et al.Acceptance of pain in neurological disorders:associations with function and psychosocial wellbeing[J].Rehabil Psychol,2013,58(1):1-9.

[12]王栋,贺西京,李浩鹏,等.抗抑郁药物及康复治疗缓解胸腰段脊髓损伤患者中枢性疼痛23例[J].中国临床康复,2004,8 (14):2638.

[13]Giardino ND,Jensen MP,Turner JA,et al.Social environment moderates the association between catastrophizing and pain among persons with a spinal cord injury[J].Pain,2003, 106(1-2):19-25.

[14]Budh CN,Hultling C,Molander C,et al.Neuropathic pain after traumatic spinal cord injury－relations to gender,spinal level,completeness,and age at the time of injury[J].Spinal Cord, 2004,42(12):665-673.

[15]Heutink M,Post MWM,Wollaars MM,et al.Chronic spinal cord injury pain:pharmacological and non-pharmacological treatments and treatment effectiveness[J].Disabil Rehabil, 2011,33(5):433-440.

[16]Norrbrink C,Lundeberg T.Acupuncture and massage therapy for neuropathic pain following spinal cord injury:an exploratory study[J].Acupunct Med,2011,29(2):108-115.

[17]Degenhardt BF,Darmani NA,Johnson JC,et al.Role of osteo-pathic manipulative in altering pain biomarkers:a pilot study[J].JAm OsteopathAssoc,2007,107(9):387-400.

[18]Arienti C,Daccò S,Piccolo I,et al.Osteopathic manipulative treatment is effective on pain control associated to spinal cord injury[J].Spinal Cord,2010,49(4):515-519.

[19]Wong JY,Rapson LM.Acupuncture in the management of pain of musculoskeletal and neurologic origin[J].Phys Med Rehabil Clin NorthAm,1999,10(3):531-545.

[20]Dyson-Hudson TA,Shiflett SC,Kirshblum SC,et al.Acupuncture and trager psychophysical integration in the treatment of wheelchair user's shoulder pain in individuals with spinal cordinjury[J].ArchPhysMedRehabil,2001,82(8): 1038-1046.

[21]Lee JY,Choi DC,Oh TH,et al.Analgesic effect of acupuncture is mediated via inhibition of JNK activation in astrocytes after spinal cord injury[J].PLoS One,2013,8(9):e73948.

[22]Dyson-Hudson TA,Kadar P,LaFountaine M,et al.Acupuncture for chronic shoulder pain in persons with spinal cord injury:a small-scale clinical trial[J].Arch Phys Med Rehabil, 2007,88(10):1276-1283.

[23]Nayak S,Shiflett SC,Schoenberger NE,et al.Is acupuncture effective in treating chronic pain after spinal cord injury?[J]. Arch Phys Med Rehabil,2001,82(11):1578-1586.

[24]Rapson LM,Wells N,Pepper J,et al.Acupuncture as a promising treatment for below-level central neuropathic pain:a retrospective study[J].J Spinal Cord Med,2003,26(1):21-26.

[25]樊留博,马利中,王韵.电针夹脊穴治疗脊髓损伤后中枢性疼痛疗效观察[J].上海针灸杂志,2011,30(3):149-150.

[26]Ditor DS,Latimer AE,Ginis KA,et al.Maintenance of exercise participation in individuals with spinal cord injury:effects on quality of life,stress and pain[J].Spinal Cord,2003,41(8): 446-450.

[27]Nash MS,van de Ven I,van Elk N,et al.Effects of circuit resistance training on fitness attributes and upper-extremity pain in middle-aged men with paraplegia[J].Arch Phys Med Rehabil,2007,88(1):70-75.

[28]Finley MA,Rodgers MM.Effect of 2-speed geared manual wheelchair propulsion on shoulder pain and function[J].Arch Phys Med Rehabil,2007,88(12):1622-1627.

[29]Jensen MP,Barber J,Hanley MA,et al.Long term outcome of hypnotic analgesia treatment for chronic pain in persons with disabilities[J].Int J Clin Exp Hypn,2008,56(2):156-169.

[30]Norrbrink Budh C,Kowalski J,Lundeberg T.A comprehensive pain management programme comprising educational, cognitive and behavioural interventions for neuropathic pain following spinal cord injury[J].J Rehabil Med,2006,38(3): 172-180.

[31]Perry KN,Nicholas MK,Middleton JW.Comparison of a pain management program with usual care in a pain management center for people with spinal cord injury-related chronic pain[J].Clin J Pain,2010,26(3):206-216.

[32]Pleger B,Tegenthoff M,Ragert P,et al.Sensorimotor retuning in complex regional pain syndrome parallels pain reduction[J]. Ann Neurol,2005,57(3):425-429.

[33]Korn ER.Visualization techniques and altered states of consciousness[M]//Sheikh AA.Handbook of Therapeutic Imagery Techniques.Amityville,NY:Baywood Publishing Company Inc.,2002:41-49.

[34]Villiger M,Hepp-Reymond MC,Pyk P,et al.Virtual reality rehabilitation system for neuropathic pain and motor dysfunction in spinal cord injury patients[C].Zurich,Switzerland:9th International Conference on Virtual Rehabilitation,2011.

[35]Soler MD,Kumru H,Pelayo R,et al.Effectiveness of transcranial direct current stimulation and visual illusion on neuropathic pain in spinal cord injury[J].Brain,2010,133(9): 2565-2577.

[36]Mehta S,Orenczuk K,McIntyre A,et al.Neuropathic pain post spinal cord injury part 1:systematic review of physical and behavioral treatment[J].Top Spinal Cord Inj Rehabil, 2013,19(1):61-77.

[37]Tan G,Rintala DH,Thornby JI,et al.Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury[J].J Rehabil Res Dev,2006,43(4):461-474.

[38]Fregni F,Gimenes R,Valle AC,et al.A randomized, sham-controlled,proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia[J].Arthritis Rheum,2006,54(12):3988-3998.

[39]Defrin R,Grunhaus L,Zamir D,et al.The effect of a series of repetitive transcranial magnetic stimulations of the motor cortex on central pain after spinal cord injury[J].Arch Phys Med Rehabil,2007,88(12):1574-1580.

[40]Kang BS,Shin HI,Bang MS.Effect of repetitive transcranial magnetic stimulation over the hand motor cortical area on central pain after spinal cord injury[J].Arch Phys Med Rehabil, 2009,90(10):1766-1771.

[41]Johnson M,Martinson M.Efficacy of electrical nerve stimulation for chronic musculoskeletal pain:a meta-analysis of randomized controlled trials[J].Pain,2007,130(1-2):157-165.

[42]Cheing GL,Hui-Chan CW.Transcutaneous electrical nerve stimulation:nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain[J].Arch Phys Med Rehabil,1999,80(3):305-312.

[43]Panagos A,Jensen M,Cardenas DD.Treatment of myofascial shoulder pain in the spinal cord injured population using staticmagnetic fields:a case series[J].J Spinal Cord Med,2004,27 (2):138-142.

[44]Gajraj NM.Pregablin:its pharmacology and use in pain management[J].AnesthAnalg 2007,105:1805-1815.

[45]Finnerup NB,Sindrup SH,Bach FW,et al.Lamotrigine in spinal cord injury pain:a randomized controlled trial[J].Pain, 2002,96(3):375-383.

[46]Finnerup NB,Grydehoj J,Bing J,et al.Levetiracetam in spinal cord injury pain:a randomized controlled trial[J].Spinal Cord,2009,47(12):861-867.

[47]Vranken JH,Hollmann MW,van der Vegt MH,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):267-273.

[48]Rintala DH,Holmes SA,Courtade D,et al.Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury[J].Arch Phys Med Rehabil,2007,88(12):1547-1560.

[49]Finnerup NB,Biering-Sorensen F,Johannesen IL,et al.Intravenous lidocaine relieves spinal cord injury pain:a randomized controlled trial[J].Anesthesiology,2005,102(5):1023-1030.

[50]Kvarnstrom A,Karlsten R,Quiding H,et al.The analgesic effect of intravenous ketamine and lidocaine on pain after spinal cord injury[J].ActaAnaesthesiol Scand,2004,48(4):498-506.

[51]Chiou-Tan FY,Tuel SM,Johnson JC,et al.Effect of mexiletine on spinal cord injury dysesthetic pain[J].Am J Phys Med Rehabil,1996,75(2):84-87.

[52]Uchikawa K,Toikawa H,Liu M.Subscapularis motor point block for spastic shoulders in patients with cervical cord injury[J].Spinal Cord,2009,47(3):249-251.

[53]Marciniak C,Rader L,Gagnon C.The use of botulinum toxin for spasticity after spinal cord injury[J].Am J Phys Med Rehabil,2008,87(4):312-317.

[54]Barrera-Chacon JM,Mendez-Suarez JL,Jáuregui-Abrisqueta ML,et al.Oxycodone improves pain control and quality of life in anticonvulsant-pretreated spinal cord-injured patients with neuropathic pain[J].Spinal Cord,2011,49(1):36-42.

[55]Wade DT,Robson P,House H,et al.A preliminary controlled study to determine whether whole-plant cannabis extreacts can improve intractable neurogenic symptoms[J].Clin Rehabil, 2003,17(1):21-29.

[56]Hagenbach U,Luz S,Ghafoor N,et al.The treatment of spasticity with Delta 9-tetrahydrocannabinol in persons with spinal cord injury[J].Spinal Cord,2007,45(8):551-562.

[57]Rintala DH,Fiess RN,Tan G,et al.Effect of dronabinol on central neuropathic pain after spinal cord injury:a pilot study[J].Am J Phys Med Rehabil,2010,89(10):840-848.

[58]Ackerman LL,Follett KA,Rosenquist RW.Long-term outcomes during treatment of chronic pain with intrathecal clonidine or clonidine/opioid combinations[J].J Pain Symptom Manage,2003,26(1):668-677.

[59]Sandford PR,Benes PS.Use of capsaicin in the treatment of radicular pain in spinal cord injury[J].J Spinal Cord Med, 2000,23(4):238-243.

[60]蔡长华.硬膜外脊髓电刺激治疗慢性疼痛研究现状[J].创伤与急危重病医学,2014,2(1):23-25.

[61]Livshits A,Rappaport ZH,Livshits V,et al.Surgical treatment of painful spasticity after spinal cord injury[J].Spinal Cord, 2002,40(4):161-166.

[62]Chun HJ,Kim YS,Yi HJ.A modifed microsurgical DREZotomy procedure for refractory neuropathic pain[J].World Neurosurg,2011,75(3-4):551-557.

[63]Nashold BS.Paraplegia and pain[M]//Nashold BS,Ovelmen-Levitt J.Deafferentation Pain Syndromes:Pathophysiology and Treatment.New York:Raven Press Ltd.,1991:301-319.

[64]赖光辉,李玄英,倪家骧.全脊髓毁损术治疗截瘫后神经痛的临床研究[J].首都医科大学学报,2014,35(1):10-12.

Clinical Research Evidences for Pain after Spinal Cord Injury(review)

WANG Yu-ming,TANG Li,LI Jian-jun.Capital Medical University School of Rehabilitation Medicine,Department of General Surgery,Beijing Bo'ai Hospital,China Rehabilitation Research Center, Beijing 100068,China

Pain is a common complication after spinal cord injury.Clinical studies involve pain mechanisms,classifications and treatments,etc.Pain after spinal cord injury needs comprehensive treatment.However,each of these interventions may produce only small curative effect,so this article aims to emphasize the best evidences and provide clear,wise and prudent evidences for clinical decision by reviewing clinical researches about pain after spinal cord injury.

spinal cord injury;pain;rehabilitation;review

10.3969/j.issn.1006-9771.2014.10.012

R651.2

A

1006-9771(2014)10-0945-05

2014-05-29

2014-06-30)

1.中国康复研究中心北京博爱医院脊柱脊髓功能重建科，北京市100068；2.首都医科大学康复医学院，北京市100068。作者简介：王玉明(1965-)，男，内蒙古包头市人，硕士，副主任医师，主要研究方向：骨科、脊柱脊髓损伤。