Dor central em pacientes com traumatismo raquimedular: proposta de um protocolo terapêutico
Keywords:
Pain, Spinal Cord Injuries, Etiology, TreatmentAbstract
Central pain in spinal cord injured patients: Proposal for a therapeutic protocol Twenty-eight medical records from the Spinal Cord Injury (SO) Unit of Associação Brasileira Beneficente de Reabilitação were randomly and retrospectively chosen and analyzed in order to compare with the literature the phamacological and physical therapeutic approaches used in the treatment of central pain caused by SCI in 1995- 1996, with the aim to show general epidemiological data and propose a simplified treatment protocol. After application of a questionnaire by means of a spontaneous interview, the groups which received physical and pharmacological treatment were statistically analyzed as well as the clinical response of each therapeutic method. Deafferentation pain was detected in 34% of SCI patients. The main etiology was gu nshot (53%), the most common level of lesion was the lower thoracic (43%) and burning was the most reported type of pain (43%). Spasticity was observed in 64% of cases and 71.5% underwent surgery. In relation to the treatments used, amitriptyline, clomipramine, carbamazepine, TENS and cinesiotherapy improved pain tolerance in 60%, 87.5%, 50%, 80% and 83% of SCI patients, respectively. No significant difference was evidenced among phamacological and physical treatment groups (p> 0.05). On the other hand, when statistical analysis was performed intragroup, only clomipramine significantly improved the clinical response (p < 0.002), probably due to the limited population studied (n= 28). Thus, we propose the following therapeutic protocols: (1) clomipramine + TENS + cinesiotherapy; (2) amitriptyline + TENS + cinesiotherapy; (3) carbamazepine + TENS + cinesiotherapy.
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