Abstract
Objective
Analyze the epidemiological data on neuropathic pain in spinal cord injury patients and determine the risk factors for its occurrence and chronicity.
Method
Review and analysis of the literature.
Results
Epidemiological data report that 40% of spinal cord injury (SCI) patients suffer from neuropathic pain and 40% of these patients report an intense neuropathic pain. Some factors do not seem to be predictive for the onset of neuropathic pain: the level of injury, complete or incomplete injury, the existence of an initial surgery, sex. However, old age at the time of injury, bullet injury as the cause of trauma, early onset of pain in the weeks following the injury, their initial nature, intensity and continuous pain, as well as associated symptoms all appear to be negative prognostic factors.
Conclusion
Neuropathic pain in SCI patients is a major issue, its determining factors still need to be evaluated properly by refining the epidemiological data.
Résumé
Objectif
Analyser les données épidémiologiques sur les douleurs neuropathiques des blessés médullaires et déterminer les facteurs de risque de leur survenue et de chronicisation.
Méthode
Revue et analyse de la littérature.
Résultats
Les données épidémiologiques retrouvent 40 % des BM avec des douleurs neuropathiques et parmi ceux-là, 40 % ont des douleurs intenses. Certains facteurs ne paraissent pas prédictifs de survenue de douleurs neuropathiques : le niveau lésionnel, le caractére complet ou incomplet de la lésion, l’existence d’une chirurgie initiale, le sexe. En revanche, l’âge avancé au moment de la lésion, la lésion balistique comme cause du traumatisme, le déclenchement précoce des douleurs dans les semaines qui suivent la lésion, leur forte intensité initiale, leur caractère continu ainsi que les comorbidités apparaissent comme facteurs pronostiques négatifs.
Conclusion
La douleur neuropathique du blessé médullaire est un problème majeur, ses facteurs déterminants restent à préciser en affinant les données épidémiologiques.
1
English version
1.1
Introduction
Pain is a major complication for many spinal cord injury (SCI) patients. In fact, it affects 70% of SCI patients. Two thirds report chronic pain, one third of them describe it as an intense pain having a negative impact on their mood and daily life activities. SCI patients see this pain as one of the worst complication associated to their neurological impairment . Its negative impact on the patients’ quality of life is well known and recognized . Pain can slow down or even interrupt a rehabilitation program and be a major hurdle to a normal social life . When pain is not properly managed or even neglected, it leads to physical and psychological disorders that are hard to treat and can trigger a chronic pain syndrome, known to be refectory to treatments.
Nociceptive pain affects 17 to 60% of this population and gets worse with time. Neuropathic pain, know for being refractory and chronic, affects more than 40% of SCI patients .
The high incidence of pain in SCI patients compared to the general population and other neurological populations, explains the increased interest for studying the various factors (level of injury, psychological and social) that could trigger its onset, development and chronicity (i.e. predictive factors). Analyzing these factors is made difficult by the coexistence and interaction of all these numerous factors, often intertwined and affecting a heterogeneous population (age, gender, sociocultural level, level and type of injury, personality…). Identifying and managing these factors in the acute stage of SCI patients’ care could improve their functional prognosis . The psychological, environmental and social predictive factors were not analyzed in our study.
1.2
Methodology
It is a literature review based on the following keywords in the French language: douleur neuropathique chronique/blessé médullaire/adulte/facteurs de risque/facteurs de chronicisation and the following keywords in the English language: chronic neuropathic pain/spinal cord injury adult/risk factors/chronicity factors.
The bibliography collected by the scientific committee was completed by the references listed for each selected article.
Eighty-five articles were kept, among them two different types of articles were found, on the one hand population-based studies (29 transversal analyses and 8 longitudinal analyses) ( Tables 1 and 2 ) on the other hand, general articles on this topic including several literature reviews. No meta analyses were found on this specific topic.
| Authors | Year | Number of individuals | Data collection method |
|---|---|---|---|
| Anke et al. | 1995 | 46 | Questionnaire |
| Botterell et al. | 1953 | 125 | Questionnaire |
| Budh and Osteråker | 2007 | 230 | Postal survey |
| Cardenas et al. | 2004 | 7379 | Questionnaire |
| Curtis et al. | 1999 | 190 | Questionnaire |
| Dalyan et al. | 1999 | 130 | Postal survey |
| Davidoff et al. | 1987 | 19 | Questionnaire |
| Davis and Martin | 1947 | 471 | Questionnaire |
| Demirel et al. | 1998 | 47 | Questionnaire |
| Finnerup et al. | 2001 | 330 | Postal survey |
| Klotz et al. | 2002 | 1668 | Postal survey |
| Levi et al. | 1995 | 350 | Questionnaire |
| Nepomuceno et al. | 1979 | 300 | Postal survey |
| Norrbrink-Budh et al. | 2003 | 456 | Questionnaire |
| Pentland et al. | 1995 | 83 | Phone survey |
| Richards et al. | 1980 | 75 | Postal survey |
| Rintala et al. | 1998 | 77 | Questionnaire |
| Rintala et al. | 2005 | 348 | Phone survey |
| Rogano et al. | 2005 | 81 | Retrospective analysis |
| Rose et al. | 1988 | 885 | Postal survey |
| Störmer et al. | 1997 | 215 | Questionnaire |
| Summers et al. | 1991 | 54 | |
| Tasker et al. | 1992 | 127 | Retrospective analysis |
| Turner et al. | 2001 | 384 | Postal survey |
| Werhagen et al. | 2004 | 402 | Retrospective analysis |
| Westgreen and Levi | 1998 | 320 | Questionnaire |
| Widerstrom-Noga and Turk | 2003 | 120 | Postal survey |
| Widerstrom-Noga and Turk | 2004 | 159 | Postal survey |
| Authors | Year | Number of individuals | Data collection method |
|---|---|---|---|
| Charlifue et al. | 1999 | 315 | Questionnaire |
| Cruz-Almeida et al. | 2005 | Questionnaire | |
| Jensen et al. | 2005 | 147 | Postal survey |
| Kennedy et al. | 1997 | 76 | Questionnaire |
| New et al. | 1997 | 23 | Questionnaire |
| Putzke et al. | 2000 | 540 | Questionnaire |
| Siddall et al. | 1999 | 100 | Questionnaire |
| Siddall et al. | 2003 | 100 | Phonesurvey |
We encountered some difficulties due to populations’ heterogeneity, studied items as well as the lack of consensus on the classifications and various assessing tools used. When possible, we had to identify among the neuropathic pain articles the ones that were SCI specific and, from all SCI-specific articles the one that dealt with neuropathic pain.
In the ( Appendix 1 ), we included, by combining them, the results of the two votes on professional practices. The first one took place among the attendees at the SOFMER conference (116 voting physicians) and the second one via the SOFMER website (50 voting physicians) .
1.3
Epidemiology of the neuropathic pain in SCI patients
1.3.1
Analytic data
SCI patients suffer from various painful syndromes. Their action mechanisms remain unclear. Davis and Martin conducted the first studies on SCI pain, without studying its specific nature, in 1947 on 571 patients and Botterell et al. in 1953 on 125 patients . They already reported their high prevalence and severity: more than 90% of the studied populations reported pain going from simple discomfort to intense pain for 30% of them. For Kuhn, in 1947, 22.5% out of 113 SCI patients reported chronic pain. Bonica , in a literature review based on 10 articles between 1947 and 1988, estimated that 69% of SCI patients were affected by painful syndromes and that 30% of these patients suffered from central neuropathic pain (central dysaesthesic pain). A Scandinavian study by Levi et al. on a cohort of 353 patients, reported 64% of discomfort pain, 30% of neuropathic pain, 17% of mixed pain and 17% of nociceptive pain. Störmer et al. reported that in a population of 901 SCI patients, 66% of them suffered from pain and dysesthesia, 50% from isolated pain, 11% from painful dysesthesia and 5% from unpleasant but painless dysesthesia.
The first authors estimated at 65% the pain incidence in SCI patients , but the most recent studies report a higher incidence. Pain, regardless of its nature, would affect in fact between 75 and 81% of the SCI population (surveys conducted in 5 different countries) .
The frequency for intense pain ranges from 25 to 60% , mean at 33% . Thirty-seven to 77% of SCI patients suffer from chronic pain that can linger for more than 10 years . Only 4 to 6% of patients report a decreased pain on the long term .
Kaplan et al. , Siddall et al. report a chronic pain increase five years after the initial injury. SCI pain is reported as more frequent and severe than in the general population . It is known for being refractory to the different treatments. .
Neuropathic pain has a major impact on the daily life of SCI patients. It disturbs their sleep, limits their daily life activities and has a negative impact on their quality of life .
1.3.1.1
Prevalence of neuropathic pain in SCI patients
It ranges, according to the different studies, from 25 to 85% . Methodological issues (heterogeneity of the studied populations, diagnosis based on a phone conversation or on clinical visit) explain such disparate results. Siddall et al. , in a longitudinal study with a five-year follow-up conducted on 100 SCI patients, found that 81% of them reported being in pain, out of these 59% suffered from musculoskeletal pain, 41% segmental SCI pain [at the level of injury], 34% SCI central pain [below the level of injury] and 5% visceral pain. Werhagen et al. in a retrospective study on 402 patients evaluated the prevalence of neuropathic pain at 40%. Rintala et al. by conducting a survey on 348 army veterans found 75% of chronic pain. Norrbrink et al. in a survey on 456 SCI patients found 45% of neuropathic pain .
The statement number: 40% of SCI patients suffer from neuropathic pain is the one most commonly found in the latest publications.
Globally, the neuropathic pain incidence in SCI patients seems to be higher than the one found for the other neurological lesions. Bonica in a literature review on central pain found the highest neuropathic pain incidence in SCI patients compared to other affections of the CNS with a 30% incidence, [less important than in the following studies where the incidence was closer to 40%] ( Table 3 ).
| Pathologies | Studied population of individuals | Prevalence (%) |
|---|---|---|
| Spinal cord injury | 225 000 | 30 |
| Multiple sclerosis | 150 000 | 23 |
| Parkinson’s Disease | 500 000 | 10 |
| Brain trauma | 2 millions | 1.5 |
Many types of pain coexist in one single patient with different underlying characteristics (nociceptive pain, neuropathic pain) that need to be differentiated in order to provide the best specific solutions to each type of pain. Often, one single SCI patient can suffer from both segmental pain and central pain. These distinctions are often uneasy to do, as for example shoulder pain .
1.3.1.2
Prevalence of segmental pain and central pain (at the level of injury and below the level of injury)
The studies’ results differ for evaluating the respective impact of neuropathic pain in regard to the level of injury (segmental pain – central pain) ( Table 4 ).
| Authors | Segmental pain (at the level of injury) (%) | Central pain (below the level of injury) (%) |
|---|---|---|
| Rintala et al. | 32 | 10 |
| Siddall et al. | 38 | 19 |
| Siddall et al. | 41 | 34 |
| Werhagen et al. | 13 | 27 |
1.3.1.3
Delay of onset of neuropathic pain
Onset of neuropathic pain occurs early only in the weeks following the initial spinal cord injury. According to the studies, 43 to 63% of patients report the onset of neuropathic pain occurring in the first six months following the injury and 80 to 95% in the first year. New et al. in his work reported that 65% of SCI patients are affected by pain right upon their admission during the acute stage, he finds the same number after one year. In more than half the cases, pain that occurs after the first year is correlated to a syrinx cavity (syringomyelia) . Looking out for the formation of a syrinx cavity is part of the systematic SCI patients’ check-up as part of their routine follow-up. Spinal cord MRI should be done systematically on a regular basis.
Segmental pain (at the level of injury) is the first one to appear, with an onset in the first months following the lesion − 46% in the first three months – . Central neuropathic pain – below the level of injury – occurs within the first year . Visceral pain [5%] has a late onset with a mean delay of 4.2 years . The delays vary according to the type of pain this might imply that different physiological action mechanisms are involved .
1.3.1.4
Neuropathic pain evolution
Neuropathic pain has a chronic progression and is quite stable over time. Charlifue et al. report a persistence of neuropathic pain during the 10 years following the initial injury. Cardenas et al. find the pain frequency stable over time – regardless of the type of pain – with a prevalence at one year in 81% of cases, and 82.7% of cases after 25 years.
The longitudinal study conducted by Siddall et al. focuses on the neuropathic pain evolution in the five years following the initial injury . Neuropathic pain lingers over time – at the level of injury and below the level of injury – without any changes in its characteristics – intensity, localization – whereas nociceptive pain decreases about six months after the initial injury to reappear some years later. Cruz Almeida et al. in an 18-month study report the stability of central neuropathic pain (below the level of injury).
1.3.1.5
Neuropathic pain severity
Fifty-eight per cent of patients suffering from neuropathic pain qualify their pain as intense or very intense after five years , 32% for Jensen et al. . Visceral pain is one of the most intense type of pain but luckily it is less common [5%] than neuropathic pain (at the level of injury or below). Intense pain is often diffused, described as burning pain or as electric shocks and associated to having a negative impact on the patient’s well-being and mood .
1.3.1.6
Neuropathic pain characteristics
SCI patients qualify their pain as: burning pain (73–90%), electric shock (12–73%), mechanical vice, pressure (27–50%) . Dysesthesia occurs more often in incomplete SCI than in complete SCI.
1.3.1.7
Pain from cauda equina and conus medullaris is classified as neuropathic pain (segmental pain at the level of injury)
Its action mechanisms are complex and can be caused by stretching, crushing or avulsion of one or more nerve roots. The symptoms are similar to the ones from brachial plexus avulsion (BPA) with shooting pain like an electric shock or burning pain .
1.3.2
Epidemiological discussion
In our analysis based on a literature review, we encountered several difficulties.
The heterogeneity of the studied populations, the lack of consensus on the definition of neuropathic pain (central pain, dysesthesia pain…), the use of different evaluation methodologies from one author to the next, made it very difficult to compare these studies . Furthermore, nociceptive pain and neuropathic pain are not differentiated in several publications. The different methodologies used for analyzing the qualifying words used by the patients to describe their pain was also another of the problems met during our analysis.
According to a report from the American Agency for Health Care and Research , out of the 591 articles compiled in the literature (before June 2000), 50% of the studies did not give any definition for neuropathic pain, 44% gave no information on the type of injury or the pain localization and 30% of the studies were conducted on populations with less than 25 patients. The relevance for studying pain and its impact has also quite progressed. In 1997, Siddall et al. , with a bibliographical review, revealed that only 19 articles focused on SCI patients’ pain out of the 2400 articles published in the past 20 years in Pain and 16 articles out of the 1700 articles published in Paraplegia .
Many classifications suggested before the years 2000 were not part of a consensus and did not benefit from a specific evaluation adapted to SCI patients . The latest pain classification for SCI patients proposed by IASP in 2000, which is nowadays the recommended classification, tried to bring an answer to these shortcomings . Since 2000, the number and quality of articles on neuropathic pain, especially in SCI patients, have largely increased; their analysis is made easier by the almost generalized use of the IASP classification. Furthermore, the distinction between nociceptive pain and neuropathic pain is often reported.
The development of specific measuring tools for evaluating the neuropathic pain (NPS, LANSS…) will also contribute to improving the legibility of these studies .
These classification and methodology issues can partly explain the highly variable or even contradictory results found in the epidemiological studies conducted on pain and consequently their identification of the predictive factors.
1.4
Predictive factors
1.4.1
Results
1.4.1.1
Injury-related factors
The results from the different studies diverge on the impact of the injury-related factors (SCI width, incomplete vs. complete SCI and level of injury: cervical, thoracic, conus medullaris and cauda equina) on the prevalence of neuropathic pain and its chronic nature.
1.4.1.2
Gunshot injuries
They lead to more severe pain with a highly negative impact on the patient’s quality of life , the nature of the injury could be the cause of the pain’s development .
1.4.1.3
Neuropathic pain and SCI severity (width)
The impact of the injury’s importance and severity has been argued many times. Some older studies reported a higher prevalence of neuropathic pain in incomplete SCI patients . Ravencroft et al., on the contrary , reported more pain cases in complete SCI patients. The most intense neurological pain was reported for incomplete SCI and cauda equina injuries . Segmental pain (at the level of injury) seems to occur more frequently in incomplete SCI patients (36%) than central SCI pain – below the level of injury – (19%) . Furthermore, allodynia is more common in this population and for cervical SCI .
Conversely, for other authors and in the most recent and well-conducted studies, neuropathic pain’s prevalence and intensity did not correlate to the type or injury.
Thus, it does not seem that the injury severity would have an impact on the prevalence and intensity of neuropathic pain .
1.4.1.4
Neuropathic pain and injury level (height)
Here again, the results are not clearly defined. Cervical SCI , thoracic SCI cauda equina injuries seem to be more often correlated to neuropathic pain. However, several studies including the most recent ones did not find a causal relationship between the level of injury and pain’s prevalence.
Siddall and Loeser , in a large bibliographical review, then Siddall et al. , in a five-year follow-up cohort study, did not unveil a correlation between, on the one hand, the occurrence and intensity of the neuropathic pain and on the other hand the level of injury or complete/incomplete type of injury.
1.4.2
Population characteristics
1.4.2.1
Age at the time of the injury
There seems to be a positive correlation between an advanced age at the time of the injury and the onset of neuropathic pain . Pain is rare for SCI that occurred in childhood . Twenty-six per cent of patients who had their injury under the age of 20 suffer from neuropathic pain versus 50% for SCI patients with an injury that occurred after the age of 50 . The Cruz-Almeida et al. study does not confirm these results.
1.4.2.2
Gender
Most SCI patients are men . Studies cannot report the correlation between gender and the prevalence of neuropathic pain (small group samples, not representative). The rare studies on this subject are quite contradictory, some of them report no differences between the men and women for the nature of the pain and its intensity as well as its impact on their daily lives . The postal survey conducted by Cardenas et al. on 7379 SCI patients seems to confirm these data. Conversely, a Swedish study with 456 SCI patients on the prevalence of pain at one-year post-injury reports more pain in women than in men. Rintala et al. describe that half the men and three quarter of the women suffer from chronic pain. Furthermore, women seem to suffer more from nociceptive pain and have a higher rate of pain-relief medication consumption .
1.4.2.3
Population aging
Pain, regardless of its nature, seems to be more intense with age , the same results are also found for quadriplegic patients essentially affected by Myofascial Pain Syndrome (MPS). Pentland, however, did not report any causal link between aging, time elapsed since injury and the progression of pain in SCI patients . For Weitzenkamp, aging is correlated to a pain decrease in the lower limbs (neuropathic pain) and a pain increase in the upper limbs (mechanical pain) .
1.4.3
Pain characteristics and its evolution
The intensity level of chronic neuropathic pain depends on the severity and quick-setting onset of the initial pain. The initial neuropathic pain’s intensity level seems to predict the severity of this pain after five years. The patients reporting little or no pain in the first year post-injury seem to be the ones that report less pain after five years. SCI patients who reported intense pain at first, continue to suffer from intense neuropathic pain on the long term .
In the Kennedy study, 80% of SCI patients report neuropathic pain six weeks post-injury and 64% report some pain one year after their initial injury [and among them, 80% declared that their pain started on the day of the injury] .
Pain’s intensity is higher when the pain is continuous than for intermittent pain .
1.4.4
Surgery’s impact
We find many different opinions on this subject. Burke suggests that the surgery plays a major role in developing secondary pain caused by muscles and ligaments lesions. Conversely, Davidoff et al. studied the relationships between a certain number of variables and the occurrence of SCI central pain (below the level of injury), they report more central neuropathic pain in SCI patients who did not benefit from surgery than in patients who did. However, three studies did not find any differences between patients who had surgery and those who did not.
1.4.5
Associated symptoms and pain
There are very few articles available in the literature on this topic even though it is a common observation in daily clinical practices. Ravencroft and Widerström and Turk reported in their cofactor analysis a correlation between pain and the following symptoms: fatigue, infection, spasticity, constipation, urine retention. A positive relationship is found between joint mobilization (long term physical exercises) and pain (regardless of its nature or characteristics), pain is also reported as having a negative impact on the patients’ mood .
Widerström-Noga et al. on a study comparing two groups of quadriplegics (1 with autonomic dysreflexia and 1 without) found the same prevalence of pain in both groups, but the group suffering from autonomic dysreflexia described pain as being more diffuse, used more specific words to describe the pain, reported more sadness and anxiety, more spasms, more urinary tract infections and constipation. Klotz et al. unveiled a common link between neuropathic pain and other SCI complications like pressure ulcers. Störmer et al. found a higher risk of neuropathic pain in SCI patients suffering from bowel incontinence with constipation.
1.5
Discussion
To identify the predictive factors we are faced with, the same results variability due to the classification and methodology issues: pain definition differs according to each author, the studied populations are heterogeneous in terms of age, type of injury and the evaluation methods are different from the studied factors.
At the time being, the available data from the literature does not allow us to answer two essential questions:
- •
What are the predictive factors for the onset of neuropathic pain in SCI patients?
- •
What are the factors having an impact on the intensity or the chronicity of the neuropathic pain in SCI patients?
Besides these issues, several factors do not seem to have an impact on the onset of neuropathic pain:
- •
level of injury;
- •
complete or incomplete SCI;
- •
spinal cord injury;
- •
gender.
However, other factors seem to have an impact as a predictive factor for the prevalence or severity of neuropathic pain:
- •
old age at the time of the injure as a negative prognostic factor;
- •
gunshot wound being the cause of the trauma;
- •
the early onset of pain in the weeks following the initial injury, initial intense pain, continuous pain;
- •
associated pathologies (pressure ulcers, constipation, infections…) having a negative impact on pain.
In spite of a low level of evidence, it seems legitimate to advise to seek out and treat all the associated pathologies that could have a negative impact on segmental or central pain (at the level of injury or below the level of injury, whether the area is totally anesthetized or not). Nowadays, there seems to be a causal relationship between the existence of a spinal stenosis and the onset of a syrinx cavity and the subsequent onset of secondary pain .
1.6
Conclusion
Neuropathic pain is one of the major complications of spinal cord injury. It affects around 40% of SCI patients and 50% of these patients report a major impairment. It has an early onset in the first year following the initial injury and becomes chronic. Neuropathic pain must be evaluated as part of the SCI patients’ routine rehabilitation care.
When faced with SCI patients suffering from neuropathic pain, looking out for predictive factors and trying to treat them as early on as possible is essential for the patients and their future.
Appendix 1
Results of the votes on professional practices based on 116 attendees at the SOFMER conference and other 50 participants who voted via the SOFMER website
Question 4a: Do you systematically evaluate the neuropathic pain of SCI patients in your healthcare organization (clinic or hospital)?
dnk: 1.81%
yes: 78.99%
no: 19.20%
Question 4b: What is your estimated percentage of SCI patients suffering from neuropathic pain?
46,61%
Question 4c: When faced with neuropathic pain, do you systematically prescribed a specific treatment for this neuropathic pain [anti-seizure drugs or tricyclic antidepressant drugs TCAs] or do you wait for a spontaneous remission?
dnk: 1.20%
No, I do not prescribe a systematic treatment, I wait for a spontaneous improvement: 1.40%
No, I do not prescribe a systematic treatment, I treat first the triggering factors (associated symptoms): 20.08%
Yes, but only if the pain is very intense: 14.10%
Yes, when faced with neuropathic pain in SCI patients, I systematically prescribe a specific treatment: 54.22%
dnk: does not know
2
Version française
2.1
Introduction
La douleur est un problème fréquent qui fait partie des séquelles majeures des blessés médullaires (BM). Elle touche en effet près de 70 % de cette population. Les deux tiers sont des douleurs chroniques, un tiers d’entre elles sont décrites comme des douleurs intenses ayant un retentissement important à très important sur l’humeur et le fonctionnement. Elles sont perçues par cette population comme une des pires complications accompagnant le handicap neurologique . Son impact négatif sur la qualité de vie est reconnu . Elle peut ralentir ou même interrompre la rééducation et représenter un obstacle à la réinsertion sociale . Insuffisamment prise en compte ou négligée, elle entraîne, si elle persiste, des perturbations physiques et psychologiques difficilement réversibles spontanément à l’origine d’un syndrome douloureux chronique, bien connu pour sa résistance aux traitements.
Les douleurs par excès de nociception touchent 17 à 60 % de cette population et s’aggravent avec l’âge. Les douleurs neurologiques réputées pour leur caractère rebelle et leur évolution chronique concernent plus de 40 % des BM .
L’incidence élevée des douleurs chez les paraplégiques comparée à la population générale et aux autres populations neurologiques, explique l’intérêt croissant porté sur l’étude des facteurs tant lésionnels que psychologiques et sociaux pouvant favoriser leur apparition, leur développement et leur chronicisation (facteurs prédictifs). Leur exploration est rendue difficile par la coexistence et l’interaction de ces facteurs qui sont multiples, souvent intriqués et qui affectent une population hétérogène (âge, sexe, niveau socioculturel, niveau et type de lésion, personnalité…). L’identification et le contrôle de ces facteurs dès la phase précoce de la prise en charge du BM permettrait d’améliorer le pronostic fonctionnel . Les facteurs prédictifs psychologiques, sociaux et environnementaux n’ont pas été analysés dans notre étude.
2.2
Méthodologie
Il s’agit d’une revue de la littérature effectuée à partir des mots clés suivants : douleur neuropathique chronique/blessé médullaire/adulte/facteurs de risque/facteurs de chronicisation.
La bibliographie collectée par le comité scientifique a été complétée par les bibliographies propres aux articles consultés.
Quatre-vingt quatre articles ont été retenus, parmi lesquels deux types d’articles sont ressortis, d’une part des études de populations (29 analyses transversales et 8 analyses longitudinales) ( Tableaux 1 et 2 ), d’autre part des articles généraux sur le sujet dont nombre de revues de la littérature. Il n’a pas été retrouvé de méta-analyse sur ce thème précis.
| Auteurs | Année | Nombre de sujets | Recueil des données |
|---|---|---|---|
| Anke et al. | 1995 | 46 | Questionnaire |
| Botterell et al. | 1953 | 125 | Questionnaire |
| Budh et Osteråker | 2007 | 230 | Enquête postale |
| Cardenas et al. | 2004 | 7379 | Questionnaire |
| Curtis et al. | 1999 | 190 | Questionnaire |
| Dalyan et al. | 1999 | 130 | Enquête postale |
| Davidoff et al. | 1987 | 19 | Questionnaire |
| Davis et Martin | 1947 | 471 | Questionnaire |
| Demirel et al. | 1998 | 47 | Questionnaire |
| Finnerup et al. | 2001 | 330 | Enquête postale |
| Klotz et al. | 2002 | 1668 | Enquête postale |
| Levi et al. | 1995 | 350 | Questionnaire |
| Nepomuceno et al. | 1979 | 300 | Enquête postale |
| Norrbrink-Budh et al. | 2003 | 456 | Questionnaire |
| Pentland et al. | 1995 | 83 | Enquête téléphonique |
| Richards et al. | 1980 | 75 | Enquête postale |
| Rintala et al. | 1998 | 77 | Questionnaire |
| Rintala et al. | 2005 | 348 | Enquête téléphonique |
| Rogano et al. | 2005 | 81 | Analyse rétrospective |
| Rose et al. | 1988 | 885 | Enquête postale |
| Störmer et al. | 1997 | 215 | Questionnaire |
| Summers et al. | 1991 | 54 | |
| Tasker et al. | 1992 | 127 | Analyse rétrospective |
| Turner et al. | 2001 | 384 | Enquête postale |
| Werhagen et al. | 2004 | 402 | Analyse rétrospective |
| Westgreen et Levi | 1998 | 320 | Questionnaire |
| Widerstrom-Noga et Turk | 2003 | 120 | Enquête postale |
| Widerstrom-Noga et Turk | 2004 | 159 | Enquête postale |
| Auteurs | Année | Nombre de sujets | Mode de recueil |
|---|---|---|---|
| Charlifue et al. | 1999 | 315 | Questionnaire |
| Cruz-Almeida et al. | 2005 | Questionnaire | |
| Jensen et al. | 2005 | 147 | Enquête postale |
| Kennedy et al. | 1997 | 76 | Questionnaire |
| New et al. | 1997 | 23 | Questionnaire |
| Putzke et al. | 2000 | 540 | Questionnaire |
| Siddall et al. | 1999 | 100 | Questionnaire |
| Siddall et al. | 2003 | 100 | Enquête téléphonique |
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