Capsule pour l’action pour LM (2nd ed., 2013)
En présence de LM, il faut évaluer régulièrement la douleur et savoir distinguer la douleur neuropathique de la douleur musculosquelettique.
Le problème:
De 48 à 94% des personnes ayant une lésion médullaire (LM) présentent des douleurs chroniques. La douleur associée à la LM est difficile à diagnostiquer puisque jusqu’à neuf types de douleurs différentes peuvent survenir au même endroit, seuls ou en association. En gros, la douleur a deux grandes origines possibles : centrale (neuropathie) ou périphérique (musculosquelettique). Souvent, les deux types de douleur coexistent. La prise en charge de la douleur diffère significativement selon son origine.
Pratiques d’excellence fondées sur des preuves:
Les personnes ayant une LM se posent bien des questions sur leur douleur et ont souvent la sensation que personne ne la comprend, y compris leur médecin de famille. La mesure de douleur la plus répandue, l’échelle visuelle analogique à 10 points (EVA), est inadéquate devant la douleur complexe reliée à la LM. L’évaluation complète de cette douleur nécessite d’évaluer les éléments suivants : site, fréquence, intensité, durée et caractéristiques de la douleur, moment d’apparition et impact sur le fonctionnement.
Le DN4 (Douleur neuropathique en 4 Questions) est un instrument de dépistage permettant de bien distinguer entre la douleur neuropathique et la douleur musculosquelettique, et dont on a démontré la sensibilité, la spécificité et la validité supérieure. Au-delà de la valeur seuil de 4/10, le DN4 présente une sensibilité de 84 % et une spécificité de 92 % (voir document ci-joint).
Source clé:
Spallone, V., Morganti, R., D’Amato, C., Greco, C., Cacciotti., L., & Marfia, G.A. (2012). Validation of DN4 as a screening tool for neuropathic pain in painful diabetic polyneuropathy. Diabetic Medicine, 29(5): 578-85.
Références supplémentaires:
Bennett, M. (2001). The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain,92(1-2): p. 147-57. http://dx.doi.org/10.1016/S0304-3959(00)00482-6
Budh, C.N., et al. (2003). Pain in a Swedish spinal cord injury population. Clinical Rehabilitation, 17(6): 685-690. http://dx.doi.org/10.1191/0269215503cr664oa
Cardenas, D. D., & Felix, E. R. (2009). Pain after Spinal Cord Injury: A Review of Classification, Treatment Approaches, and Treatment Assessment. Physical Medicine and Rehabilitation, 1(12): 1077-1090.
Celik, E.C., Erhan, B., & Lakse, E. (2012). The clinical characteristics of neuropathic pain in patients with spinal cord injury. Spinal Cord, 50: 585-89.
Cruz-Almeida, Y., Felix, E. R., Martinez-Arizala, A., & Widerstrom-Noga, E. G. (2009). Pain symptom profiles in persons with spinal cord injury. Pain Medicine, 10(7): 1246-1259.
De Miguel, M., & Kraychete, D. C. (2009). Pain in patients with spinal cord injury: A review. [Portuguese, English]. Revista Brasileira de Anestesiologia,59(53): 350-357.
Dijkers, M., Bryce, T., & Zanca, J. (2009). Prevalence of chronic pain after traumatic spinal cord injury: a systematic review. Journal of Rehabilitation Research & Development, 46(1): 13-29.
http://www.rehab.research.va.gov/jour/09/46/1/absdijkers.html
Felix, E. R., & Widerstrom-Noga, E. G. (2009). Reliability and validity of quantitative sensory testing in persons with spinal cord injury and neuropathic pain. Journal of Rehabilitation Research & Development, 46(1): 69-83.
Finnerup, N.B., et al. (2001). Pain and dysesthesia in patients with spinal cord injury: A postal survey. Spinal Cord, 39(5): 256-62. http://dx.doi.org/10.1038/sj.sc.3101161
Finnerup, N.B., et al. (2008). Abdominal pain in long-term spinal cord injury. Spinal Cord, 46(3): 198-203. http://dx.doi.org/10.1038/sj.sc.3102097
Furlan, J.C., Noonan, V., Singh, A, & Fehlings, M.G. (2011). Assessment of impairment in patients with acute traumatic spinal cord injury: A systematic review of the literature. Journal of Neurotrauma, 28: 1445-47.
Goossens, D, Dousse, M., Ventura, M., & Fattal, C. (2009). Chronic neuropathic pain in spinal cord injury patients: What is the impact of social and environmental factors on care management? Annals of Physical and Rehabilitation Medicine, 52(2):173-9.
Haanpaa, M. (2011). Are neuropathic pain screening tools useful for patients with spinal cord injury? Pain, 152(2011): 715-16.
Hallstrom, H., & Norrbrink, C. (2011). Screening tools for neuropathic pain: Can they be of use in individuals with spinal cord injury? Pain, 152(2011): 772-79.
Hans, G., Masquelier E., & De Cock, P. (2007). The diagnosis and management of neuropathic pain in daily practice in Belgium: an observational study. BMC Public Health, 7: 170.
http://dx.doi.org/10.1186/1471-2458-7-170
Jensen, M. P., Moore, M. R., Bockow, T. B., Ehde, D. M., & Engel, J. M. (2011). Psychosocial factors and adjustment to chronic pain in persons with physical disabilities: a systematic review. Archives of Physical Medicine & Rehabilitation, 92(1): 146-160.
Jensen, M.P., Widerstrom-Noga, E., Richards, J.S., Finnerup, N.B., Biering-Sorensen, F., & Cardenas, D.D. (2010). Reliability and validity of the International Spinal Cord Injury Basic Pain Data Set items as self-report measures. Spinal Cord, 48(3): 230-8.
Margot-Duclot, A., Tournebise, H., Ventura, M., & Fattal, C. (2009). What are the risk factors of occurrence and chronicity of neuropathic pain in spinal cord injury patients? Annals of Physical and Rehabilitation Medicine, 52(2): 111-23.
Masson, E. (2009). Chronic neuropathic pain in spinal cord injury patients: What is the impact of social and environmental factors on care management? Annals of Physical and Rehabilitation Medicine, 52(2): 173-179.
Modirian, E., Pirouzi, P., Soroush, M., Karbalaei-Esmaeili, S., Shojaei, H., & Zamani, H. (2010). Chronic pain after spinal cord injury: results of a long-term study. Pain Medicine, 11(7): 1037-1043.
Norman, C., Bender, J.L., Macdonald, J., Dunn, M., Dunne, S., Siu, B., Hitzig, S.L., et al. (2010). Questions that individuals with spinal cord injury have regarding their chronic pain: a qualitative study. Disability Rehabilitation, 32(2): 114-24.
Sawatzky, B., et al. (2008). Classification and measurement of pain in the spinal cord-injured population. Spinal Cord, 46(1): 2-10. http://dx.doi.org/10.1038/sj.sc.3102137
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http://dx.doi.org/10.1016/S0304-3959%2802%2900452-9
Ullrich, P.M., Jensen, M.P. Loeser J.D., & Cardenas, D.D. (2008). Pain intensity, pain interference and characteristics of spinal cord injury. Spinal Cord, 46(6): 451-5.
Widerstrom-Noga, E. G., Cruz-Almeida, Y., Felix, E. R., & Adcock, J. P. (2009). Relationship between pain characteristics and pain adaptation type in persons with SCI. Journal of Rehabilitation Research & Development, 46(1): 43-56.
Actionable Nuggets for Spinal Cord Injury 