Floris V Raasveld, Maxime R A Tiems, Benjamin R Johnston, Omar Moussa, Ian L Valerio, David Hao, J Henk Coert, Kyle R Eberlin
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引用次数: 0
Abstract
Introduction: Peripheral nerve injuries (PNIs) resulting from trauma or surgery can lead to neuropathic pain and, in some cases progress to centralized pain. This condition significantly affects patients' quality of life and functional abilities. However, diagnostic criteria for centralized pain following PNI remain poorly defined, complicating patient identification and treatment. This systematic review aims to assess current diagnostic approaches and propose evidence-based criteria for clinical diagnosis.
Methods: A systematic search of MEDLINE, Embase, Web of Science, and CENTRAL was conducted for studies assessing diagnostic approaches for centralized pain following PNI. Included studies addressed clinical characteristics, diagnostic tests, or signs of centralized pain after PNI. Exclusion criteria included acute pain studies (<3 months), pediatric patients, and non-English articles.
Results: From 950 citations screened, 28 studies (6,189 patients) were included. Based on the synthesized evidence, we propose the following diagnostic criteria for centralized pain following PNI: (1)documented peripheral nervous system injury or compression, (2)neuropathic pain persisting for three months, (3)hyperalgesia, allodynia, or other forms of hypersensitivity extending beyond the primary zone of injury, (4)associated mood/cognitive disturbances, and (5)limited response to peripheral nerve blocks, defined as less than <50% pain reduction, if performed.
Conclusions: This study proposes a comprehensive, evidence-based diagnostic framework for centralized pain following PNI. The algorithm combines clinical criteria with optional diagnostic testing, providing a practical approach for diagnosis that accounts for variability in access to advanced diagnostic tools. By standardizing the diagnostic process, the framework aims to enhance patient identification and support appropriate treatment selection in clinical practice.
由创伤或手术引起的周围神经损伤（PNIs）可导致神经性疼痛，在某些情况下进展为集中疼痛。这种情况显著影响患者的生活质量和功能能力。然而，PNI后集中疼痛的诊断标准仍然不明确，使患者识别和治疗复杂化。本系统综述旨在评估当前的诊断方法，并提出临床诊断的循证标准。方法：系统检索MEDLINE、Embase、Web of Science和CENTRAL，以评估PNI后集中疼痛诊断方法的研究。纳入的研究涉及PNI后的临床特征、诊断测试或集中疼痛的体征。排除标准包括急性疼痛研究(结果：从950篇文献中筛选，包括28项研究（6189例患者）。基于综合证据，我们提出以下诊断PNI后集中疼痛的标准：(1)周围神经系统损伤或压迫，(2)神经性疼痛持续三个月，(3)痛觉过敏、异常性疼痛或其他形式的超敏反应延伸到主要损伤区之外，(4)相关的情绪/认知障碍，(5)周围神经阻滞反应有限，定义为小于本研究提出了一个全面的、基于证据的PNI后集中疼痛诊断框架。该算法将临床标准与可选的诊断测试相结合，提供了一种实用的诊断方法，说明了获得先进诊断工具的可变性。通过标准化诊断过程，该框架旨在加强患者识别和支持临床实践中适当的治疗选择。
期刊介绍：
The Clinical Journal of Pain explores all aspects of pain and its effective treatment, bringing readers the insights of leading anesthesiologists, surgeons, internists, neurologists, orthopedists, psychiatrists and psychologists, clinical pharmacologists, and rehabilitation medicine specialists. This peer-reviewed journal presents timely and thought-provoking articles on clinical dilemmas in pain management; valuable diagnostic procedures; promising new pharmacological, surgical, and other therapeutic modalities; psychosocial dimensions of pain; and ethical issues of concern to all medical professionals. The journal also publishes Special Topic issues on subjects of particular relevance to the practice of pain medicine.
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