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Management of pain in individuals with spinal cord injury: Guideline of the German-Speaking Medical Society for Spinal Cord Injury

机译：脊髓损伤患者的疼痛管理：德语的脊髓损伤医学会指南

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>Introduction: Pain is a prominent complication in spinal cord injury (SCI). It can either occur as a direct or as an indirect consequence of SCI and it often heavily influences the quality of life of affected individuals. In SCI, nociceptive and neuropathic pain can equally emerge at the same time above or below the level of injury. Thus, classification and grading of pain is frequently difficult. Effective treatment of SCI-related pain in general and of neuropathic pain in particular is challenging. Current treatment options are sparse and their evidence is considered to be limited. Considering these aspects, a clinical practice guideline was developed as basis for an optimized, comprehensive and standardized pain management in SCI-related pain.>Methods: The German-Speaking Medical Society for Spinal Cord Injury (Deutschsprachige Medizinische Gesellschaft für Paraplegiologie – DMGP) developed a clinical practice guideline that received consensus from seven further German-speaking medical societies and one patient organization. The evidence base from clinical trials and meta-analyses was summarized and subjected to a structured consensus-process in accordance with the regulations of the Association of Scientific Medical Societies in Germany (AWMF) and the methodological requirements of the “German instrument for methodological guideline appraisal”.>Results: This consensus-based guideline (S2k classification according to the AWMF guidance manual and rules) resulted in seven on-topic statements and 17 specific recommendations relevant to the classification, assessment and therapy of pain directly or indirectly caused by SCI. Recommended therapeutic approaches comprise pharmacological (e.g. nonsteroidal anti-inflammatory drugs or anticonvulsants) and non-pharmacological (e.g. physical activity or psychotherapeutic techniques) strategies for both nociceptive and neuropathic pain.>Discussion: Assessment of SCI-related pain is standardized and respective methods in terms of examination, classification and grading of pain are already in use and validated in German language. In contrast, valid, evidence-based and efficient therapeutic options are limited and ask for further clinical studies, ideally randomized controlled trials and meta-analyses.
机译：>简介：疼痛是脊髓损伤（SCI）的主要并发症。它可以作为SCI的直接或间接结果发生，并且通常会严重影响受影响个体的生活质量。在脊髓损伤中，伤害性伤害和神经性疼痛可能会在伤害水平以上或以下同时出现。因此，疼痛的分类和分级通常是困难的。一般而言，有效治疗SCI相关疼痛尤其是神经性疼痛具有挑战性。当前的治疗方案很少，其证据被认为是有限的。考虑到这些方面，制定了临床实践指南，作为SCI相关疼痛的优化，全面和标准化疼痛管理的基础。>方法：德语德语脊髓医学会（Deutschsprachige Medizinische Gesellschaft Paraplegiologie（DMGP）制定了一项临床实践指南，该指南得到了另外七个德语国家的医学会和一个患者组织的一致认可。总结了来自临床试验和荟萃分析的证据基础，并根据德国科学医学会协会（AWMF）的规定和“德国方法学指南评估工具”的方法学要求进行了结构化的共识程序”。>结果：这项基于共识的指南（根据AWMF指导手册和规则进行的S2k分类）得出了7项关于主题的陈述和17条与疼痛的分类，评估和治疗直接相关的具体建议或由SCI间接引起。推荐的治疗方法包括针对伤害性和神经性疼痛的药理（例如非甾体类抗炎药或抗惊厥药）和非药理（例如体育活动或心理治疗技术）策略。>讨论：评估SCI相关疼痛已被标准化，并且在疼痛的检查，分类和等级方面的各种方法已经在使用中，并且已经过德语验证。相反，有效，循证和有效的治疗选择受到限制，需要进一步的临床研究，理想的随机对照试验和荟萃分析。

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