Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942009000300011
Brazilian Journal of Anesthesiology
Review Article

Dor no paciente com lesão medular: uma revisão

Pain in patients with spinal cord injury: a review

Marcia de Miguel; Durval Campos Kraychete

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Resumo

JUSTIFICATIVA E OBJETIVOS: A dor crônica após a lesão medular é uma condição clínica de alta prevalência e de difícil tratamento. Desse modo, é importante que se conheça suas características clínicas e fatores causais para melhor abordagem diagnóstica e terapêutica. O objetivo desse trabalho foi revisar a literatura sobre a dor no paciente com lesão medular e sua possível associação com fatores físicos (nível da lesão, grau da lesão, tempo de início de dor) e fatores psicológicos (humor e qualidade de vida). CONTEÚDO: Foram pesquisados trabalhos na base de dados Medline, publicados nos últimos seis anos e os critérios de inclusão foram os estudos originais em maiores de 18 anos. Foram discutidas as características clínicas da dor no paciente com lesão medular, comparando casuística de diversos autores. CONCLUSÕES: Apesar das diferenças conceituais e metodológicas entre os estudos, as prevalências de dor encontradas em pacientes com lesão medular foram altas, variando entre 64% e 82%. A dor neuropática ao nível da lesão tem início precoce (dias ou semanas) e aquela abaixo do nível da lesão aparece mais tardiamente (meses ou anos). Não há associação entre dor e integridade da lesão e a porcentagem de pacientes que referem dor intensa varia entre 21 e 39%. Não foi possível concluir qual a relação entre a dor e o nível da lesão medular. A dor, no entanto, pode interferir de forma negativa no humor, na capacidade de realizar atividades cognitivas, sociais, recreacionais e laborativas.

Palavras-chave

DOR, Crônica, qualidade de vida

Abstract

BACKGROUND AND METHODS: Chronic pain after spinal cord injury is a highly prevalent clinical condition, which is difficult to treat. Therefore, it is important to know its clinical characteristics and causes for a better diagnostic and therapeutic approach. The objective of this study was to review the literature on pain in patients with spinal cord injury and the possible association with physical (level of the injury, completeness of lesion, pain duration) and psychological (mood and quality of life) factors. CONTENTS: Original studies in the Medline database with patients older than 18 years and published over the last six years were reviewed. The clinical characteristics of pain in patients with spinal cord injury are discussed, and the works of several authors are compared. CONCLUSIONS: Despite conceptual and methodological differences among the studies, the prevalence of pain in patients with spinal cord injury was high, varying from 64% to 82%. Neuropathic pain at the level of the injury has an early onset (days or weeks), while that below the level of the injury has a late onset (months or years). An association between pain and integrity of the lesion is not observed, and the percentage of patients who complain of severe pain varies from 21% to 39%. It was not possible to conclude which is the relationship between pain and level of spinal cord injury. However, pain can have a negative influence on mood and in the capacity to perform cognitive, social, recreational, and work-related activities.

Keywords

PAIN, Chronic, quality of life

References

Ravenscroft A, Ahmed YS, Burnside IG. Chronic pain after SCI: a patient survey. Spinal Cord. 2000;38:611-614.

Ehde DM, Jensen MP, Engel JM. Chronic pain secondary to disability: a review. Clin J Pain. 2003;19:3-17.

Go BK, DeVivo MJ, Richards JS. The epidemiology of spinal cord injury. Spinal Cord Injury. 1995:170-184.

Siddall PJ, Taylor DA, Cousins MJ. Classification of pain following spinal cord injury. Spinal Cord. 1997;35:69-75.

Siddall PJ, Taylor DA, McClelland JM. Pain report and the relationship of pain to physical factors in the first 6 months following spinal cord injury. Pain. 1999;81:187-197.

Ravenscroft AJ, Ahmed YS, Burnside IG. Chronic pain after spinal cord injury: a survey of practice in UK spinal cord injury units. Spinal Cord. 1999;37:25-28.

Management of chronic central neuropathic pain following traumatic spinal cord injury: executive summary of evidence report/technology assessment: number 45. J Pain Palliat Care Pharmacother. 2003;17(2):99-109.

Siddall PJ, Yezierski RP, Loeser JD. Pain following spinal cord injury: clinical features, prevalence, and taxonomy. Int Assoc Study Pain Newsletter. 2000;3:3-7.

Siddall PJ, McClelland JM, Rutkowski SB. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain. 2003;103:249-257.

Turner JA, Cardenas DD, Warms CA. Chronic pain associated with spinal cord injuries: a community survey. Arch Phys Med Rehabil. 2001;82:501-509.

Widerström-Noga EG, Felipe-Cuervo E, Yezierski RP. Relationships among clinical characteristics of chronic pain after spinal cord injury. Arch Phys Med Rehabil. 2001;82:1191-1197.

Von Korff M, Ormel J, Keefe FJ. Grading the severity of chronic pain. Pain. 1992;50:133-149.

Mariano AJ. Chronic pain and spinal cord injury. Clin J Pain. 1992;8:87-92.

Cairns DM, Adkins RH, Scott MD. Pain and depression in acute traumatic spinal cord injury: origins of chronic problematic pain?. Arch Phys Med Rehabil. 1996;77:329-335.

Summers JD, Rapoff MA, Varghese G. Psychosocial factors in chronic spinal cord injury pain. Pain. 1991;47:183-189.

Anke AG, Stenehjem AE, Stanghelle JK. Pain and life quality within 2 years of spinal cord injury. Paraplegia. 1995;33:555-559.

Subbarao JV, Klopfstein J, Turpin R. Prevalence and impact of wrist and shoulder pain in patients with spinal cord injury. J Spinal Cord Med. 1995;18:9-13.

Kessler R, Mroczek D. Final version of our psychological distress scale. 2001.

Widerström-Noga EG, Felipe-Curvo E, Broton JG. Perceived difficulty in dealing with consequences of spinal cord injury. Arch Phys Med Rehabil. 1999;80:580-586.

Siddall PJ, Xu CL, Cousins MJ. Allodynia following traumatic spinal cord injury in the rat. NeuroReport. 1995;6:1241-1244.

Xu XJ, Hao JX, Aldskogius H. Chronic pain-related syndrome in rats after ischemic spinal cord lesion: a possible animal model for pain in patients with spinal cord injury. Pain. 1992;48:279-290.

Yezierski RP. Pain following spinal cord injury: the clinical problem and experimental studies. Pain. 1996;68:185-194.

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