بررسي شيوع دردهاي خيالي در بيماران دچار ضايعه نخاعي

Frequency of Phantom Pain among patients with Spinal Cord Injury

اين مطالعه مشاهده اي، توصيفي و مقطعي با حجم نمونه 270 بيمار دچار ضايعه نخاعي در شهر تهران طي سال 1384 كه شامل دو گروه جانبازان ومعلولين بوده اند، انجام شده است. ميانگين سني افراد 12.2± 37.8سال بوده و 26.3% مؤنث و 73.7% مذكر بودند. در 17.4 % ضايعه نخاعي در سطح گردني، 41.5 % سينه اي، 38.1 % كمري و 3 % دم اسبي بود. نوع ضايعه در 76.3 % كامل و در 23.7 % ناكامل بود. طول مدت ضايعه در19.3 % كمتر از 5 سال، در 11.9 % 5 تا 10 سال و در 68.9 % بالاي 10 سال بود. درد خيالي در زير سطح ضايعه در 89 نفر (33 %) از بيماران وجود داشت كه بدين ترتيب 26% از جانبازان و 37% از معلولين چنين دردي را گزارش مي نمودند. در اين مطالعه ارتباط آماري معني داري بين تأهل، سن و طول مدت ضايعه با وجود درد خيالي مشاهده گرديد (0.05>P). در انتها بايد گفت كه ميزان شيوع دردهاي خيالي در اين مطالعه نسبت به كليه مطالعه پيشين پايينتر است و هيچ بيماري به هيچ يك از درمانها پاسخ مناسبي نداده است كه مي تواند ريشه در فيزيوپاتولوژي اين نوع درد در مقايسه با ساير انواع دردهاي ناشي از قطع نخاع داشته باشد.

Summary: Background: Patients with spinal cord injury (SCI) usually have permanent and often devastating neurologic deficits and disability and pain (1). According to the National Institutes of Health, "among neurological disorders, the cost to society of automotive SCI is exceeded only by the cost of mental retardation"(2). Neurogenic pain constitutes one of the enigmatic clinical syndromes faced by patients, clinicians, and researchers (3). Materials and Methods: Current observational descriptive cross-sectional survey is performed among 270 patients with spinal cord injuries including veterans and non-veteran disabled subjects in Tehran-City during 2005. Results: Mean age of the subjects was 37.8±12.2 years. 26.3% were female and 73.7% were male. 17.4% had spinal cord injury in cervical level, 41.5% thoracic, 38.1% lumbar, and 3% Quada Equina level. 76.3% had complete and 23.7% incomplete injuries. 19.3% had injury duration of less than 5 years, 11.9% between 5 to 10 years, and 68.9% upper than 10 years. Phantom pain below the lesion level was present in 89 patients (33%) that included 26% of veterans and 37% of non-veterans. There was a statistically significant association between age, marital status, and injury duration with having phantom pain (P< 0.05). Conclusion: it is concluded that frequency of phantom pain in current study is less than all of previous studies and our patients were totally resistant to analgesic treatments which may be due to physiopathologic basis of such pains in comparison with other pains due to spinal cord injuries.