Spinal Kord Yaralanmalarında Nöropatik Ağrı

ÖZET Giriş Spinal kord yaralanması (SKY); fiziksel, psikolojik ve sosyal fonksiyon bozukluklarına neden olabilen yıkıcı bir hastalıktır. SKY sonrası nöropatik ağrı (NPA) sık karşılaşılan komplikasyonlardandır ve SKY sonrası oluşan tedavisi en zor problemlerden biridir. SKY sonrası fonksiyon kayıplarına NPA’nın da eklenmesiyle hastaların uyku düzenleri, duygu durumları ve günlük yaşam aktiviteleri olumsuz etkilenir. SKY sonrası görülen NPA tedavisi çoğu zaman zordur ve tedaviye yanıt almak da uzun zaman alabilir. Bu çalışmada SKY olan hastalarda nöropatik ağrı durumu araştırılmıştır. Materyal ve Metod Spinal kord yaralanmalı 52 hasta çalışmaya dahil edildi. Hastaların demografik ve klinik özellikleri incelendi. Ağrının şiddetini değerlendirmek için Vizuel Analog Skala( VAS), nöropatik ağrıyı tanımlamak ve değerlendirmek için S-LANSS ölçeği kullanıldı. 18 yaş altı, 65 yaş üstü diğer nöropati kaynağı olabilecek hastalığı bulunanlar , semptomatik bölgede herhangi bir ek cilt hastalığı bulunanlar, SKY dışında immobiliteye neden olan diğer hastalıkları olanlar çalışmaya dahil edilmedi. Bulgular Hastaların yaş ortalaması 42,25±18,12 yıl iken, VAS ve S-Lanns skoru median değerleri [sırasıyla 6 (0-10) ve 11 (0-24)] olarak saptandı. Hastaların %63,5’i erkek, %67,3’ü ASİA A, %67,3’ü paraplejikti. Hastaların %30,8’inin pregabalin, %19,2’sinin ise gabapentin kullandığı tespit edildi. Nöropatik ağrı olasılığı yüksek (S-lanns ≥12) olan hastalarda VAS skorlarının istatistiksel olarak anlamlı şekilde yüksek olduğu [7 (4-10) vs 3,5 (0-9), p<0.001] saptandı, bununla birlikte yaş ve cinsiyete göre anlamlı fark saptanmadı. Sonuç SKY hastalarda S-LANSS anketi ile belirlenen NA sıklığının yüksek olduğu bulundu. Bu nedenle rutin klinikte SKY ‘lı hastalar nöropatik ağrı varlığı açısından da dikkatle muayene edilmeli ve uygun tedaviler verilmelidir. Anahtar Kelimeler : Spinal Kord Yaralanması, Nöropatik Ağrı, S-LANSS Background Spinal cord injury (SCI) is a destructive condition causing additional physical, psychological and social function disorders. Neuropathic pain (NP) following SCI is a common and challenging problem to treat. The addition of the NP following SCI increases the impairment of the sleep patterns, moods, and daily life activities of the patients. Treatment of NP following SCI is often difficult and often requires a long time to respond to treatment. The study aimed to investigate the neuropathic pain condition in patients with SCI. Material and Methods The study included 52 patients with spinal cord injuries. Including the demographics and clinical characteristics, The Visual Analog Scale (VAS) was used to define the intensity of the pain and a self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) was used to assess the neuropathic symptoms and signs. The cases under the age of 18, and over the age of 65 with conditions that might have neuropathic origins, having dermatological diseases in the symptomatic region, and other clinical issues that may cause immobility besides SCI, were not included in the study. Results The mean age was 42,25±18,12 years. The median scores of VAS and S-LANSS were 6 (0-10) and 11 (0-24), respectively. The majority were male, ASIA A, and paraplegic (63.5%, 67.3%, and 67.3%, respectively). The rates of patients on pregabalin and gabapentin were 30.8% and 19.2%, respectively. The VAS scores of patients with a higher probability of neuropathic pain (S-LANSS≥12) were significantly increased (7 (4-10) vs 3,5 (0-9), p<0.001). There were no significant differences in terms of age and gender. Conclusion Among SCI patients, the frequency of NP detected by using S-LANSS was increased. Therefore, patients with SCI might require a more careful examination regarding neuropathic pain and thus receive appropriate treatments in routine clinical practice.

Anahtar Kelimeler:

Spinal Kord Yaralanması, Nöropatik Ağrı, S-LANSS

Neuropathic Pain in Spinal Cord Injuries

Aim: Spinal cord injury (SCI) is a destructive condition causing additional physical, psychological, and social function disorders. Neuropathic pain (NP) following SCI is a common and challenging problem to treat. The addition of the NP following SCI increases the impairment of the sleep patterns, moods, and daily life activities of the patients. Treatment of NP following SCI is often difficult and often requires a long time to respond to treatment. The study aimed to investigate the neuropathic pain condition in patients with SCI. Methods: The study included 52 patients with spinal cord injuries. Including the demographics and clinical characteristics, The Visual Analog Scale (VAS) was used to define the intensity of the pain, and a self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) was used to assess the neuropathic symptoms and signs. The cases under the age of 18, and over 65 with conditions that might have neuropathic origins, ones with dermatological diseases in the symptomatic regions, and other clinical issues that may cause immobility besides SCI, were not included in the study. Results:The mean age was 42,25±18,12 years. The median scores of VAS and S-LANSS were 6 (0-10) and 11 (0-24), respectively. The majority were male, ASIA A, and paraplegic (63.5%, 67.3%, and 67.3%, respectively). The rates of patients on pregabalin and gabapentin were 30.8% and 19.2%, respectively. The VAS scores of patients with a higher probability of neuropathic pain (S-LANSS≥12) were significantly increased (7 (4-10) vs 3,5 (0-9), p<0.001). There were no significant differences in terms of age and gender. Conclusions: Among SCI patients, the frequency of NP detected by using S-LANSS were increased. Therefore, patients with SCI might require a more careful examination regarding neuropathic pain and thus receive appropriate treatments in routine clinical practice.

Keywords:

Spinal Cord Injuries, Neuralgia, S-LANSS,

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