Klinik Araştırma
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İnmeli Hastalarda Nöropatik Ağrı Sıklığı ve Medikal Tedavi Yaklaşımları

Yıl 2022, Cilt: 2 Sayı: 2, 24 - 28, 28.08.2022
https://doi.org/10.29228/HMJ.16

Öz

Amaç: Nöropatik ağrı, inme sonrası dönemde görülebilen ve hastanın yaşam kalitesini, ruh halini ve rehabilitasyon programına katılımını etkileyen bir durumdur. Bu çalışmadaki amacımız inmeli hastalarda nöropatik ağrı sıklığını araştırmak ve uygun tedavi alıp almadıklarını incelemektir.
Metod: Çalışma retrospektif, tek merkezli bir klinik araştırma olarak tasarlandı. Haziran 2021-Haziran 2022 tarihleri arasında hastanemizin Fizik Tedavi ve Rehabilitasyon polikliniğine inme tanısıyla başvuran hastalar çalışmaya dahil edildi. Afazi, kognitif disfonksiyon, subaraknoid kanama, arteriyovenöz malformasyon, tümör, travmatik beyin hasarı, kompleks bölgesel ağrı sendromu öyküsü olan hastalar çalışma dışı bırakıldı. Hastalarla telefon görüşmesi yapılarak, plejik tarafı ve ağrısının şiddeti (numerik ağrı skalası ile) soruldu. Nöropatik ağrı açısından S-LANSS (Self – Leeds Assesment of Neuropathic Symptoms and Signs) anketi yapıldı. Hastanın bu ağrı için kullandığı ilaçlar sorgulandı.
Bulgular: Bu çalışmaya toplam 41 hasta (22 erkek, 19 kadın) dahil edildi. Hastaların ortalama yaşı 63,54 ± 10,97 yıl idi. 22 sağ hemiplejik ve 19 sol hemiplejik hasta vardı. Nöropatik ağrı sıklığı %41,5 (17 hasta) idi. Nöropatik ağrısı olan kişilerde Numerik ağrı skalası, S-LANSS skoru (p=0,0001) ve gabapentinoid kullanımı (p=0,014) anlamlı olarak daha yüksek bulundu.
Sonuç: inmeli hastalarda nöropatik ağrı sıklığı belirgin şekilde yüksek bulunmuştur. Nöropatik ağrının saptanması ve uygun şekilde tedavi edilmesinin inme hastalarının yaşam kalitesi üzerine olumlu etkileri olacaktır

Kaynakça

  • 1. Belagaje SR. Stroke Rehabilitation. Contin Lifelong Learn Neurol [Internet]. 2017 Feb;23(1):238–53. Available from: http://journals.lww.com/00132979-201702000-00017
  • 2. Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet [Internet]. 2008 May;371(9624):1612–23. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673608606947
  • 3. Goodman CW, Brett AS. A Clinical Overview of Off-label Use of Gabapentinoid Drugs. JAMA Intern Med [Internet]. 2019 May 1;179(5):695. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2019.0086
  • 4. Liampas A, Velidakis N, Georgiou T, Vadalouca A, Varrassi G, Hadjigeorgiou GM, et al. Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis. Adv Ther [Internet]. 2020 Jul 23;37(7):3278–91. Available from: https://link.springer.com/10.1007/s12325-020-01388-w
  • 5. Şahin-Onat Ş, Ünsal-Delialioğlu S, Kulaklı F, Özel S. The effects of central post-stroke pain on quality of life and depression in patients with stroke. J Phys Ther Sci [Internet]. 2016;28(1):96–101. Available from: https://www.jstage.jst.go.jp/article/jpts/28/1/28_jpts-2015-790/_article
  • 6. Koc, R., & Erdemoglu, A. K. (2010). Validity and reliability of the Turkish Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire. Pain Medicine, 11(7) 1107-1114. s-lanss-agri-skalasi-toad.
  • 7. Kilic Z, Erhan B, Gunduz B, Iska Elvan G. Central Post-Stroke Pain in Stroke Patients: Incidence and the Effect on Quality of Life. Türkiye Fiz Tip ve Rehabil Derg [Internet]. 2015 Aug 4;61(2):142–7. Available from: http://www.ftrdergisi.com/eng/makale/3836/293/Full-Text
  • 8. Bekircan-Kurt CE, Inan B, Bulut O, Sengun I, Karli N, Gunes HN, et al. Neuropathic Pain Frequency in Neurology Outpatients: A Multicenter Study. Arch Neuropsychiatry [Internet]. 2021; Available from: http://submission.noropsikiyatriarsivi.com/default.aspx?s=public~kabul&mId=27549
  • 9. Klit H, Finnerup NB, Andersen G, Jensen TS. Central poststroke pain: A population-based study. Pain [Internet]. 2011 Apr;152(4):818–24. Available from: https://journals.lww.com/00006396-201104000-00019
  • 10. Hansen AP, Marcussen NS, Klit H, Andersen G, Finnerup NB, Jensen TS. Pain following stroke: A prospective study. Eur J Pain [Internet]. 2012 Sep;16(8):1128–36. Available from: https://onlinelibrary.wiley.com/doi/10.1002/j.1532-2149.2012.00123.x
  • 11. Misra UK, Kalita J, Kumar B. A Study of Clinical, Magnetic Resonance Imaging, and Somatosensory-Evoked Potential in Central Post-Stroke Pain. J Pain [Internet]. 2008 Dec;9(12):1116–22. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1526590008006457
  • 12. Bowsher D. The management of central post-stroke pain. Postgrad Med J [Internet]. 1995 Oct 1;71(840):598–604. Available from: https://pmj.bmj.com/lookup/doi/10.1136/pgmj.71.840.598
  • 13. Sezgin Özcan D, Köseoğlu BF, Taşkın MK, Tekin B, Hatipoğlu ŞC. A Condition Confused with Complex Regional Pain Syndrome in Hemiplegia: Simultaneous Occurance of Knee Osteonecrosis and Monoarthritis. Fiz Tıp ve Rehabil Bilim Derg [Internet]. 2018;21(2):95–8. Available from: http://www.jpmrs.org/current-issue/hemiplejide-kompleks-bolgesel-agri-sendromu-ile-karisabilen-bir-durum-es-zamanli-gorulen-diz-osteonekrozu-ve-monoartrit-654
  • 14. Gokçe Ş, Çigdem B. Efficacy of mirtazapine in neuropathic pain model. Anatol J Psychiatry [Internet]. 2020;21:1. Available from: http://alpha-psychiatry.com/en/efficacy-of-mirtazapine-in-neuropathic-pain-model-13987
  • 15. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol [Internet]. 2010 Sep 7;17(9):1113. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1468-1331.2010.02999.x
  • 16. Tarsuslu T, Yümin ET, Oztürk A, Yümin M. [The relation between health-related quality of life and pain, depression, anxiety, and functional independence in persons with chronic physical disability]. Agri [Internet]. 2010 Jan;22(1):30–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20209412
  • 17. Appelros P. Prevalence and predictors of pain and fatigue after stroke: a population-based study. Int J Rehabil Res [Internet]. 2006 Dec;29(4):329–33. Available from: https://journals.lww.com/00004356-200612000-00010
  • 18. Koca TT, Gülkesen A, Nacitarhan V, Koca Ö. Does Kinesiophobia Associated with Poststroke Neuropathic Pain and Stroke Severity? Fiz Tıp ve Rehabil Bilim Derg [Internet]. 2019;22(2):60–5. Available from: http://www.jpmrs.org/current-issue/kinezyofobi-nme-sonrasi-noropa2k-agri-ve-nme-sidde2-ile-liskili-midir--686

The Frequency of Neuropathic Pain In Stroke Patients and Medical Treatment Approaches

Yıl 2022, Cilt: 2 Sayı: 2, 24 - 28, 28.08.2022
https://doi.org/10.29228/HMJ.16

Öz

Background/Aim: Neuropathic pain is a condition that can be seen in the post-stroke period and affects the patient's quality of life, mood, and participation in the rehabilitation program. Our aim in this study is to investigate the frequency of neuropathic pain in stroke patients and to examine whether they receive appropriate treatment.
Method: This study was designed as a retrospective, single-center clinical trial. Patients with stroke who applied to our physical medicine and rehabilitation outpatient clinic between June 2021 and June 2022 were included in the study. Patients with history of aphasia, cognitive dysfunction, subarachnoid hemorrhage, arteriovenous malformation, tumor, traumatic brain injury, complex regional pain syndrome were excluded from the study. The plegic side, the severity of pain with the numerical pain scale (NPS) and neuropathic pain with the S-LANSS (Self – Leeds Assesment of Neuropathic Symptoms and Signs) questionnaire were questioned by making phone calls with the patients. The drug treatments they used were questioned.
Results: A total of 41 patients (22 male, 19 female) were included in this study. The mean age of the patients was 63.54 ± 10.97 years. There were 22 right hemiplegic and 19 left hemiplegic patients. Neuropathic pain frequency was 41.5% (17 patients). NPS, S-LANSS (p = 0.0001) and gabapentinoid use (p = 0.014) were found to be significantly higher in people with neuropathic pain.

Conclusion: The frequency of neuropathic pain was found to be significantly higher in stroke patients. Detecting neuropathic pain and treating it appropriately will improve the quality of life of stroke patients.

Kaynakça

  • 1. Belagaje SR. Stroke Rehabilitation. Contin Lifelong Learn Neurol [Internet]. 2017 Feb;23(1):238–53. Available from: http://journals.lww.com/00132979-201702000-00017
  • 2. Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet [Internet]. 2008 May;371(9624):1612–23. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673608606947
  • 3. Goodman CW, Brett AS. A Clinical Overview of Off-label Use of Gabapentinoid Drugs. JAMA Intern Med [Internet]. 2019 May 1;179(5):695. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2019.0086
  • 4. Liampas A, Velidakis N, Georgiou T, Vadalouca A, Varrassi G, Hadjigeorgiou GM, et al. Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis. Adv Ther [Internet]. 2020 Jul 23;37(7):3278–91. Available from: https://link.springer.com/10.1007/s12325-020-01388-w
  • 5. Şahin-Onat Ş, Ünsal-Delialioğlu S, Kulaklı F, Özel S. The effects of central post-stroke pain on quality of life and depression in patients with stroke. J Phys Ther Sci [Internet]. 2016;28(1):96–101. Available from: https://www.jstage.jst.go.jp/article/jpts/28/1/28_jpts-2015-790/_article
  • 6. Koc, R., & Erdemoglu, A. K. (2010). Validity and reliability of the Turkish Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire. Pain Medicine, 11(7) 1107-1114. s-lanss-agri-skalasi-toad.
  • 7. Kilic Z, Erhan B, Gunduz B, Iska Elvan G. Central Post-Stroke Pain in Stroke Patients: Incidence and the Effect on Quality of Life. Türkiye Fiz Tip ve Rehabil Derg [Internet]. 2015 Aug 4;61(2):142–7. Available from: http://www.ftrdergisi.com/eng/makale/3836/293/Full-Text
  • 8. Bekircan-Kurt CE, Inan B, Bulut O, Sengun I, Karli N, Gunes HN, et al. Neuropathic Pain Frequency in Neurology Outpatients: A Multicenter Study. Arch Neuropsychiatry [Internet]. 2021; Available from: http://submission.noropsikiyatriarsivi.com/default.aspx?s=public~kabul&mId=27549
  • 9. Klit H, Finnerup NB, Andersen G, Jensen TS. Central poststroke pain: A population-based study. Pain [Internet]. 2011 Apr;152(4):818–24. Available from: https://journals.lww.com/00006396-201104000-00019
  • 10. Hansen AP, Marcussen NS, Klit H, Andersen G, Finnerup NB, Jensen TS. Pain following stroke: A prospective study. Eur J Pain [Internet]. 2012 Sep;16(8):1128–36. Available from: https://onlinelibrary.wiley.com/doi/10.1002/j.1532-2149.2012.00123.x
  • 11. Misra UK, Kalita J, Kumar B. A Study of Clinical, Magnetic Resonance Imaging, and Somatosensory-Evoked Potential in Central Post-Stroke Pain. J Pain [Internet]. 2008 Dec;9(12):1116–22. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1526590008006457
  • 12. Bowsher D. The management of central post-stroke pain. Postgrad Med J [Internet]. 1995 Oct 1;71(840):598–604. Available from: https://pmj.bmj.com/lookup/doi/10.1136/pgmj.71.840.598
  • 13. Sezgin Özcan D, Köseoğlu BF, Taşkın MK, Tekin B, Hatipoğlu ŞC. A Condition Confused with Complex Regional Pain Syndrome in Hemiplegia: Simultaneous Occurance of Knee Osteonecrosis and Monoarthritis. Fiz Tıp ve Rehabil Bilim Derg [Internet]. 2018;21(2):95–8. Available from: http://www.jpmrs.org/current-issue/hemiplejide-kompleks-bolgesel-agri-sendromu-ile-karisabilen-bir-durum-es-zamanli-gorulen-diz-osteonekrozu-ve-monoartrit-654
  • 14. Gokçe Ş, Çigdem B. Efficacy of mirtazapine in neuropathic pain model. Anatol J Psychiatry [Internet]. 2020;21:1. Available from: http://alpha-psychiatry.com/en/efficacy-of-mirtazapine-in-neuropathic-pain-model-13987
  • 15. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol [Internet]. 2010 Sep 7;17(9):1113. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1468-1331.2010.02999.x
  • 16. Tarsuslu T, Yümin ET, Oztürk A, Yümin M. [The relation between health-related quality of life and pain, depression, anxiety, and functional independence in persons with chronic physical disability]. Agri [Internet]. 2010 Jan;22(1):30–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20209412
  • 17. Appelros P. Prevalence and predictors of pain and fatigue after stroke: a population-based study. Int J Rehabil Res [Internet]. 2006 Dec;29(4):329–33. Available from: https://journals.lww.com/00004356-200612000-00010
  • 18. Koca TT, Gülkesen A, Nacitarhan V, Koca Ö. Does Kinesiophobia Associated with Poststroke Neuropathic Pain and Stroke Severity? Fiz Tıp ve Rehabil Bilim Derg [Internet]. 2019;22(2):60–5. Available from: http://www.jpmrs.org/current-issue/kinezyofobi-nme-sonrasi-noropa2k-agri-ve-nme-sidde2-ile-liskili-midir--686
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sinirbilim, Rehabilitasyon
Bölüm Araştırma Makaleleri
Yazarlar

Nurten Nas Kırdar 0000-0002-6507-7880

Hande Şenol 0000-0001-6395-7924

Erken Görünüm Tarihi 27 Ağustos 2022
Yayımlanma Tarihi 28 Ağustos 2022
Gönderilme Tarihi 8 Temmuz 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 2 Sayı: 2

Kaynak Göster

Vancouver Nas Kırdar N, Şenol H. The Frequency of Neuropathic Pain In Stroke Patients and Medical Treatment Approaches. HTD / HMJ. 2022;2(2):24-8.

e-ISSN: 2791-9935