循证综述:慢性腰痛和软组织综合征存在神经病理性疼痛的证据  

What Is the Evidence that Neuropathic Pain Is Present in Chronic Low Back Pain and Soft Tissue Syndromes? An Evidence-Based Structured Review

作　　者：David A.Fish bain 韩奇[1] 王晓雷[1] 陈萌蕾[2] 朱玫娟[3] 郑拥军[1] 王祥瑞[3] 

机构地区：[1]复旦大学附属华东医院 [2]复旦大学附属肿瘤医院 [3]上海交通大学医学院附属仁济医院

出　　处：《中国疼痛医学杂志》2015年第10期721-731,共11页Chinese Journal of Pain Medicine

摘　　要：目的:本综述旨在提供慢性腰痛和软组织综合征与神经病理性疼痛是否相关的证据,以及两者中神经病理性疼痛的患病率。方法:研究的816例患者中,11例慢性腰痛患者存在神经病理性疼痛诊断,5例软组织综合征患者存在神经病理性疼痛诊断。研究分组依据神经病理性疼痛的诊断方法,如体格检查、神经病理性疼痛量表类型等。神经病理性疼痛的患病率为各组研究中所有患者的合计。慢性腰痛和软组织综合征中神经病理性疼痛的患病率为两者各自研究中所有患者的总和。两名评价者独立根据11项质量标准对每个研究做出质量评分,依据卫生保健政策和研究机构(AHCPR)指南评估各分组证据的强度和一致性。结果:各分组中所有研究报道均存在神经病理性疼痛。慢性腰痛中神经病理性疼痛的患病率是36.6%,软组织综合征中神经病理性疼痛的患病率是41.1%。不同的神经病理性疼痛诊断方法间患病率存在显著差异。结论:所有的方法一致证实,慢性腰痛和软组织综合征患者中存在神经病理性疼痛,且合并患病率显著。这对慢性腰痛和软组织综合征的治疗有重要意义。Objective： The objectives of this evidence-based review were to review the evidence for whether neuropathic pain（NP） is associated with chronic low back pain（CLBP） and soft tissue syndromes（STS）, and review the reported prevalence percentages for NP within these syndromes. Methods： Of 816 reports, 11 addressed the diagnosis of NP in CLBP and five of NP in STS. Studies were grouped by the method of arrival at an NP diagnosis, e.g., physical examination, type of NP inventory utilized, etc. The reported prevalence of NP was determined by aggregating all the patients in all the studies in each grouping. Similarly, the reported prevalence of NP within CLBP and STS was determined by aggregating all the patients with NP from all the studies in those groups. Each study was independently rated by two raters according to 11 quality criteria generating a quality score. The strength and consistency（SAC） of the evidence represented by each grouping was rated according to Agency for Health Care Policy and Research guidelines. Results： In each grouping, 100% of the studies reported some prevalence of NP（none reported zero prevalence）. Aggregated NP prevalence for CLBP was 36.6%（SAC level A [consistent multiple studies]） and for STS 41.1%（SAC level A）. There was significant variation in prevalence according to the method utilized to diagnose NP. Conclusion： There is consistent evidence by all methods that NP is present in CLBP and STS. Reported prevalence percentages by all methods are substantial. This has significant implications for the treatment of CLBP and STS.

关 键 词：神经病理性疼痛患病率 慢性腰痛 软组织综合征 循证综述 利兹神经病理性疼痛症状与体征评价量表(LANSS) 神经病理性疼痛诊断问卷(DN4) 疼痛检测问卷 

分 类 号：R741[医药卫生—神经病学与精神病学]