前言

慢性创伤后疼痛（chronic posttraumatic pain,CPTP）是组织损伤（包括烧伤在内的任何创伤）后发展或加重的慢性疼痛^［1］。疼痛既可局限于损伤区域，亦可投射到位于该区域的神经支配区。深部躯体或内脏组织损伤后相应皮肤区域可出现牵涉痛。尽管CPTP往往发展成为神经病理性疼痛，但最新国际疾病分类-11（international classification of diseases-11,ICD-11）仍将其归类为慢性术后或创伤后疼痛。任何创伤后都可能出现慢性疼痛，严重影响患者的生活质量。随着社会现代化的快速发展，交通事故、烧伤等意外创伤事件呈现快速增长，多发创伤后的慢性疼痛发生率为46%～85%^［1］。尽管如此，目前临床上对CPTP认识不足，临床诊疗亟待规范。在此背景下，国家卫健委能力建设和继续教育中心疼痛病诊疗专项能力提升项目专家组系统检索了万方、PubMed、CochraneLibrary等国内外知名数据库，主要选择系统评价（systematic review）、Meta分析（Metaanalysis）、随机对照试验（randomized controlled trial,RCT）、专家共识（consensus）、临床指南（guideline）等高质量循证医学证据文献，采用推荐分级的评估、制定与评价（grading of recommendations assessment,development and evaluation,GRADE）分级系统证据级别及推荐强度（表1）和共识会议法，经过多次反复认真讨论，并进行在线投票，制订了本指南，为规范CPTP的诊疗提供参考和指导。本指南基于ICD-11将CPTP分为6类：慢性烧伤后疼痛（chronic pain after burns injury,CPABI）、慢性周围神经损伤后疼痛、慢性脊髓损伤后疼痛、慢性脑损伤后疼痛、慢性挥鞭伤后疼痛和慢性肌肉骨骼损伤后疼痛（chronic pain after musculoskeletal injury,CPAMSI）。

病理机制

疾病分类

1.定义及分类

烧伤后疼痛是指因烧伤造成皮肤、黏膜甚至深部组织结构破坏与完整性受损，导致皮肤神经末梢受损、暴露或受刺激，以及在烧伤病程中多种诊疗操作给患者带来的各种不愉快感觉与情感体验^［9］。烧伤后疼痛具有强度剧烈、种类多、周期长等特点。CPABI通常是由热、冷、电、化学物质、摩擦或辐射引起，在伤口愈合后至少持续3个月，并排除感染、恶性肿瘤等原因引起的疼痛以及既往已经存在并延续至今的疼痛。冯艺等^［10］认为CPABI具有神经病理性疼痛特征，常伴有感觉功能障碍或感觉缺失。Klifto等^［11］将烧伤相关神经疼痛分为直接神经损伤、神经压迫、电损伤及全身损伤继发的神经功能障碍4类。

2.流行病学

CPABI是一个严重的公共健康问题，发生率为18%～52%^［1,10］。CPABI相关影响因素包括人口社会学因素（如年龄、性别、受教育程度等）、烧伤相关因素（如烧伤面积、烧伤深度、烧伤后时间、烧伤原因、吸入性损伤、日常治疗和手术等）和心理因素（如焦虑、抑郁、创伤后应激障碍等）^［12］。

3.临床表现

烧伤创面、供皮区、植皮区等区域的疼痛、灼热、紧缩感等，往往伴瘙痒、焦虑、抑郁等。

4.诊断

有烧伤病史，局部有创面瘢痕、畸形等，烧伤创面、供皮区、植皮区等区域持续疼痛超过3个月，即可诊断CPABI。

1.定义及分类

周围神经损伤多由牵拉损伤、卡压伤、切割伤等创伤引起，神经受损后的功能恢复不完全或恢复不良会导致周围神经受损后的慢性疼痛^［13］。慢性周围神经损伤后疼痛是由周围躯体感觉神经系统受到损伤后引起的持续性复发性疼痛^［14］。根据累及部位不同，慢性周围神经损伤后疼痛分为幻肢痛、残肢痛、卡压综合征、臂丛神经损伤及其他神经干损伤等。

2.流行病学

慢性周围神经损伤后疼痛的发病率为8%～26%^［15］。

3.临床表现

临床上多表现为神经支配区域的痛觉超敏、痛觉过敏、持续性疼痛或感觉异常。疼痛性质主要表现为烧灼样、电击样、针刺样、射击样等^［16-17］。常伴随睡眠障碍、焦虑及抑郁。

4.诊断

(1)有明确的周围神经创伤病史；

(2)疼痛发作与创伤发生有明确的时间关联；

(3)疼痛发生及感觉异常部位与受累神经支配区域相对应；

(4)疼痛持续时间超过3个月以上。

1.定义及分类

脊髓损伤（spinal cord injury）是由于外伤、疾病或先天性因素造成脊髓结构和功能损害，引起损伤平面以下运动、感觉及自主神经功能障碍，导致患者部分或全部活动能力丧失。慢性脊髓损伤后疼痛是脊髓损伤后最常见的并发症，严重影响患者身心健康，给患者日常生活带来极大负担。

根据脊髓损伤疼痛分级系统，慢性脊髓损伤后疼痛可分为4类：

(1)伤害感受性疼痛，包括肌肉骨骼疼痛、内脏痛及其他伤害感受性疼痛；

(2)神经病理性疼痛，包括脊髓损伤平面疼痛、脊髓损伤平面以下疼痛及其他神经病理性疼痛；

(3)其他类疼痛，也称为功能性疼痛，如肠激惹综合征、肌纤维痛、间质性膀胱炎疼痛等；

(4)未知类型疼痛，指不能归类于上述任何类的疼痛类型^［18-19］。

2.流行病学

Siddall等^［20］研究发现，65%～85%的脊髓损伤患者存在慢性疼痛，其中约1/3为重度疼痛。Hunt等^［21］研究发现慢性脊髓损伤后疼痛中，神经病理性疼痛发病率58%，肌肉骨骼疼痛发病率56%，内脏痛发病率为20%，伤害感受性疼痛发病率45%。

3.临床表现

慢性脊髓损伤后疼痛复杂，持久且难以控制，大多表现为受伤节段神经支配区及以下部位痛觉过敏、痛觉超敏、持续性疼痛或感觉异常，疼痛多为烧灼样疼痛、刺痛、挤压痛、电击样痛和射击痛，烧灼痛是最常见的疼痛描述，下肢是最常见的疼痛部位^{［18,12-23］}。未婚和损伤程度重为独立保护因素，家庭人均月收入低、没有家人支持及没有用药为其独立危险因素。

4.诊断

(1)有明确的脊髓损伤病史；

(2)迟发性：多于脊髓损伤后几个月或几年后发生，也有少数损伤后立即发生；

(3)疼痛部位不确定：呈弥漫性，在感觉平面以下的麻痹部位范围内经常变化；

(4)疼痛的性质、程度、发作频率，变化多端，且多为自发痛；

(5)对常规止痛措施无反应或收效甚微，且易耐受、成瘾、复发等^［24］。

1.定义及分类

创伤性颅脑损伤（traumatic brain injury,TBI）是由于外部机械力导致身心和认知功能暂时或永久性损害，引起患者脑组织的结构破坏或者功能紊乱的神经系统疾病。交通事故、跌落损伤和暴力损伤是我国TBI最常见的3大原因。TBI分为轻度、中度和重度，可能会产生视觉困难、认知缺陷、疼痛、睡眠障碍、创伤后癫痫等。TBI后出现的慢性疼痛称为慢性脑损伤后疼痛。慢性脑损伤后疼痛包括头痛、肌肉骨骼疼痛、中枢性疼痛等，其中头痛最常见^［25］。

2.流行病学

慢性脑损伤后疼痛发病率超过50%，最常见的是头痛^［26］。

3.临床表现

慢性脑损伤后疼痛通常为中度疼痛，多为双侧，且局限于额部，最常见的头痛呈搏动性和压迫性。慢性脑损伤后疼痛常伴有脑震荡后综合征特征^［27-28］。除头部疼痛外，其他常见的疼痛部位有背部疼痛、手臂、腿部、关节等^［29］，主要表现为肌肉骨骼疼痛。

4.诊断

根据脑部创伤病史，结合上述临床表现及相关辅助检查结果，即可诊断。

1.定义及分类

挥鞭伤（whiplash injury）是指因身体剧烈加速或减速导致颈椎过度伸屈造成的颈椎、颈髓和颈部软组织损伤^［30］，在机动车追尾撞击、运动事故或躯体虐待中较为常见。慢性挥鞭伤后疼痛是指挥鞭伤急性期过后与挥鞭伤相关的慢性头、颈、肩等部位的疼痛。慢性挥鞭伤后疼痛参照挥鞭伤的致病机制分为4类：

（1）颈椎关节突关节损伤型；

（2）颈部韧带损伤型；

（3）颈部肌肉损伤型；

（4）颞下颌关节紊乱型^［31］。

2.流行病学

挥鞭伤后患者急性疼痛发生率为100%，慢性疼痛发生率为20%～60%［31-33］。慢性挥鞭伤后疼痛最常见的原因是颈椎关节突损伤，常见损伤关节是C2～3和C5～6关节^［32］，颈椎关节突损伤发病率为54%～60%^［33］。发生颞下颌关节紊乱的概率为44%，出现肩胛区或腰背部疼痛的概率为20%～35%^［31］。

3.临床表现

患者多在挥鞭伤后6h内出现症状，少数人伤后初期症状轻微，几日后逐渐加重。常见症状主要有颈部疼痛、头痛、颈肩痛、腰背痛、上肢放射痛、前胸痛等，可伴有颞下颌关节功能障碍、头晕、斜颈、吞咽困难、视力障碍、认知及心理异常等。

4.诊断

根据挥鞭伤病史，结合上述临床表现及相关辅助检查结果，即可诊断。

六、CPAMSI

1.定义及分类

CPAMSI是指肌肉、骨骼或关节损伤后发生的慢性疼痛^［1］。CPAMSI一般分为3类。

（1）骨骼疼痛:常由骨折引起，骨折后若急性疼痛严重或未得到及时控制则易转化为慢性疼痛。

（2）肌肉、肌腱及韧带疼痛：肌肉损伤导致肌肉组织炎症、水肿、血流减少、肌肉痉挛和激痛点形成；肌腱和韧带疼痛常因扭伤、过度牵拉等引起。

（3）关节疼痛：关节创伤会导致关节僵硬、肿胀和疼痛，如创伤性关节炎等。

2.流行病学

18.7%门诊疼痛患者是由于骨骼肌损伤所致^［1］，踝关节及膝关节骨折后慢性疼痛的发生率为61.7%^［34］，其中约30%患者为慢性神经病理性疼痛。年龄超过40岁、损伤时疼痛强度高、创伤后应激综合征、存在医学合并症、对运动恐惧等是发生CPAMSI的高风险因素^［35-36］。

3.临床表现

常见症状为局部疼痛、僵硬、疲劳、睡眠障碍、肌肉“抽搐”感等。疼痛可能与姿势或动作相关，也可能有神经病理性疼痛成分，如烧灼样、电击样、针刺样痛。症状严重程度或疼痛强度与肌肉骨骼损伤的严重程度不一定相关^［37］。

值得注意的是，慢性骨折后疼痛患者不仅肌肉骨骼功能恢复不良，还会出现抑郁、焦虑、认知障碍和复杂区域疼痛综合征^［38］。

4.诊断

目前没有CPAMSI诊断标准，创伤性与非创伤性肌肉骨骼疼痛有3个重要区别：

(1)有明确的创伤因果事件发生；

(2)疼痛与创伤后组织损伤范围和位置相关；

(3)创伤后应激症状在CPTP的发展和维持中起着重要作用。

治疗

积极治疗原发损伤、缓解疼痛、改善功能，降低致残率，提高生活质量。

常用方法包括药物治疗（表2）、物理治疗（表3）、微创介入治疗（表4）、其他治疗（表5）、外科手术（表6）等。

预防与健康宣教

参考文献

［１］ Schug SA, Lavand'homme P, Barke A, et al. IASP taskforce for the classification of chronic pain. The IASP classification of chronic pain for ICD‐11: chronic postsurgical or posttraumatic pain［J］. Pain, 2019, 160(1): 45‐52. DOI: 10.1097/j. pain. 0000000000001413.

［２］ 邢丹, 余楠生, 张长青 .《关节腔注射富血小板血浆治疗膝骨关 节炎的临床实践指南(2018 年版)》推荐意见解读及方法学评价 ［J］. 中 华 关 节 外 科 杂 志 (电 子 版), 2018, 12(4): 6‐10. DOI: 10. 3877/cma.j.issn.1674‐134X.2018.04.002.

［３］ Moldovan M, Alvarez S, Romer Rosberg M, et al. Axonal voltage‐gated ion channels as pharmacological targets for pain［J］. Eur J Pharmacol, 2013, 708(1‐3): 105‐112. DOI: 10.1016/j.ejphar. 2013.03.001.

［４］ Kuner R, Flor H. Structural plasticity and reorganisation in chronic pain［J］. Nat Rev Neurosci, 2016, 18(1): 20‐30. DOI: 10. 1038/nrn.2016.162.

［５］ Liu Y, Zhou LJ, Wang J, et al. TNF‐α differentially regulates synaptic plasticity in the hippocampus and spinal cord by microglia‐dependent mechanisms after peripheral nerve injury［J］. J Neurosci, 2017, 37(4): 871‐881. DOI: 10.1523/JNEUROSCI. 2235‐16.2016.

［６］ Ossipov MH, Morimura K, Porreca F. Descending pain modulation and chronification of pain［J］. Curr Opin Support Palliat Care, 2014, 8(2): 143‐151. DOI: 10.1097/SPC.0000000000000055.

［７］ Ong WY, Stohler CS, Herr DR. Role of the prefrontal cortex in pain processing［J］. Mol Neurobiol, 2019, 56(2): 1137‐1166. DOI: 10.1007/s12035‐018‐1130‐9.

［８］ Liu XG. Normalization of neuroinflammation: a new strategy for treatment of persistent pain and memory/emotional deficits in chronic pain［J］. J Inflamm Res, 2022, 15: 5201‐5233. DOI: 10. 2147/JIR.S379093.

［９］《中华烧伤杂志》编辑委员会 . 成人烧伤疼痛管理指南(2013 版) ［J］. 中 华 烧 伤 杂 志 , 2013, 29(3): 225‐231. DOI: 10.3760/cma.j. issn.1009‐2587.2013.03.002.

［10］ 冯艺, 许军军, 林夏清, 等 . 慢性术后或创伤后疼痛［J］. 中国疼 痛 医 学 杂 志 , 2021, 27(4): 241‐245. DOI: 10.3969/j. issn. 1006‐ 9852.2021.04.001.

［11］ Klifto KM, Hultman CS, Dellon AL. Nerve pain after burn injury: a proposed etiology‐based classification［J］. Plast Reconstr Surg, 2021, 147(3): 635‐644. DOI: 10.1097/PRS.0000000000007639.

［12］ 刘丽波, 钟月欢 . 烧伤后慢性疼痛影响因素的研究进展［J］. 护 士进修杂志, 2021, 36(21): 1958‐1961. DOI: 10.16821/j.cnki.hsjx. 2021.21.008.

［13］ Wang ML, Rivlin M, Graham JG, et al. Peripheral nerve injury, scarring, and recovery［J］. Connect Tissue Res, 2019, 60(1): 3‐9. DOI: 10.1080/03008207.2018.1489381.

［14］ Scholz J, Finnerup NB, Attal N, et al. Classification committee of the neuropathic pain special interest group (neupsig), the IASP classification of chronic pain for ICD‐11: chronic neuropathic pain ［J］. Pain, 2019, 160(1): 53‐59. DOI: 10.1097/j.pain.0000000000 001365.

［15］ 阿孜古丽·阿吉, 吴蓍妍, 陈雪, 等 . 2 型糖尿病病人痛性神经病 变与周围神经传导速度相关性研究［J］. 中国疼痛医学杂志, 2023, 29(3): 219‐225. DOI: 10.3969/j. issn. 1006‐9852.2023.03. 010.

［16］ Bouhassira D. Neuropathic pain: definition, assessment and epidemiology［J］. Rev Neurol (Paris), 2019, 175(1‐2): 16‐25. DOI: 10.1016/j.neurol.2018.09.016.

［17］ Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances［J］. Lancet, 2021, 397 (10289): 2082‐2097. DOI: 10.1016/S0140‐6736(21)00393‐7.

［18］ Dijkers MP, Bryce TN. Introducing the international spinal cord injury pain (ISCIP) classification［J］. Pain Manag, 2012, 2(4): 311‐314. DOI: 10.2217/pmt.12.35.

［19］ 赵红霞, 张继荣 . 脊髓损伤后疼痛分类的探讨［J］. 中国康复, 2015(3): 225‐228. DOI: 10.3870/zgkf.2015.03.022.

［20］ Siddall PJ, McClelland JM, Rutkowski SB, et al. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury ［J］. Pain, 2003, 103(3): 249‐257. DOI: 10.1016/S0304‐3959(02)00452‐9.

［21］ Hunt C, Moman R, Peterson A, et al. Prevalence of chronic pain after spinal cord injury: a systematic review and meta‐analysis［J］. Reg Anesth Pain Med, 2021, 46(4): 328‐336. DOI: 10.1136/ rapm‐2020‐101960.

［22］ Hatch MN, Cushing TR, Carlson GD, et al. Neuropathic pain and SCI: identification and treatment strategies in the 21st century［J］. J Neurol Sci, 2018, 384: 75‐83. DOI: 10. 1016/j.jns.2017.11.018.

［23］ Majedi H, Safdarian M, Hajiaghababaei M, et al. Characteristics of neuropathic pain in individuals with chronic spinal cord injury［J］. Neurosciences (Riyadh), 2018, 23(4): 292‐300. DOI: 10.17712/nsj. 2018.4.20180223.

［24］ Rosner J, Negraeff M, Bélanger LM, et al. Characterization of hyperacute neuropathic pain after spinal cord injury: a prospective study［J］. J Pain, 2022, 23(1): 89‐97. DOI: 10.1016/j.jpain.2021. 06.013.

［25］ Grandhi R, Tavakoli S, Ortega C, et al. A review of chronic pain and cognitive, mood, and motor dysfunction following mild traumatic brain injury: complex, comorbid, and/or overlapping conditions?［J］. Brain Sci, 2017, 7(12): 160. DOI: 10.3390/brainsci 7120160.

［26］Robayo LE, Govind V, Vastano R, et al. Multidimensional pain phenotypes after traumatic brain injury［J］. Front Pain Res (Lausanne), 2022, 3: 947562. DOI: 10.3389/fpain.2022.947562.

［27］Leung A. Addressing chronic persistent headaches after MTBI as a neuropathic pain state［J］. J Headache Pain, 2020, 21(1): 77. DOI: 10.1186/s10194‐020‐01133‐2.

［28］Ashina H, Iljazi A, Al‐Khazali HM, et al. Persistent post‐traumatic headache attributed to mild traumatic brain injury: deep phenotyping and treatment patterns［J］. Cephalalgia, 2020, 40(6): 554‐564. DOI: 10.1177/0333102420909865.

［29］ O'Neil ME, Carlson KF, Holmer HK, et al. Chronic pain in veterans and servicemembers with a history of mild traumatic brain injury: a systematic review［Internet］. Washington (DC): Department of Veterans Affairs (US), 2020.

［30］ Park AL, Hwang EH, Hwang MS, et al. Cost‐effectiveness of Chuna Manual Therapy and usual care, compared with usual careonly for people with neck pain following traffic accidents: a multicenter randomized controlled trial［J］. Int J Environ Res Public Health, 2021, 18(19): 9994. DOI: 10.3390/ijerph18199994.

［31］ 邱皓, 栾富钧, 曹春风, 等 . 挥鞭样损伤研究进展［J］. 颈腰痛杂 志 , 2015, 36(6): 508-510. DOI: 10.3969/j. issn. 1005-7234.2015. 06.003.

［32］ Cooper G, Bailey B, Bogduk N. Cervical zygapophysial joint pain maps［J］. Pain Med, 2007, 8(4): 344‐353. DOI: 10.1111/j. 1526‐ 4637.2006.00201.x.

［33］ Bogduk N. On cervical zygapophysial joint pain after whiplash ［J］. Spine (Phila Pa 1976), 2011, 36(25 Suppl): S194‐199. DOI: 10.1097/BRS.0b013e3182387f1d.

［34］ Friesgaard KD, Gromov K, Knudsen LF, et al. Persistent pain is common 1 year after ankle and wrist fracture surgery: a register‐based questionnaire study［J］. Br J Anaesth, 2016, 116(5): 655‐661. DOI: 10.1093/bja/aew069.

［35］ Pierik JG, IJzerman MJ, Gaakeer MI, et al. Incidence and prognostic factors of chronic pain after isolated musculoskeletal extremity injury［J］. Eur J Pain, 2016, 20(5): 711‐22. DOI: 10. 1002/ejp.796.

［36］ Alkassabi O, Voogt L, Andrews P, et al. Risk factors to persistent pain following musculoskeletal injuries: a systematic literature review［J］. Int J Environ Res Public Health, 2022, 19(15): 9318. DOI: 10.3390/ijerph19159318.

［37］ El‐Tallawy SN, Nalamasu R, Salem GI, et al. Management of musculoskeletal pain: an update with emphasis on chronic musculoskeletal pain［J］. Pain Ther, 2021, 10(1): 181‐209. DOI: 10.1007/s40122‐021‐00235‐2.

［38］ Zhao Y, Zhang H, Li N, et al. Chronic pain after bone fracture: Current insights into molecular mechanisms and therapeutic strategies［J］. Brain Sci, 2022, 12(8): 1056. DOI: 10.3390/brainsci 12081056.

［39］ Gordh TE, Stubhaug A, Jensen TS, et al. Gabapentin in traumatic nerve injury pain: a randomized, double‐blind, placebo‐controlled, cross‐over, multi‐center study［J］. Pain, 2008, 138(2): 255‐266. DOI: 10.1016/j.pain.2007.12.011.

［40］ Kimura Y, Yamaguchi S, Suzuki T, et al. Switching from pregabalin to mirogabalin in patients with peripheral neuropathic pain: a multi‐center, prospective, single‐arm, open‐label study (MIROP Study［J］. Pain Ther, 2021, 10(1): 711‐727. DOI: 10.1007/ s40122‐021‐00255‐y.

［41］ Nikaido T, Takatsuna H, Tabata S, et al. Efficacy and safety of add‐on mirogabalin to NSAIDs in lumbar spinal stenosis with peripheral neuropathic pain: a randomized, open‐label study［J］. Pain Ther, 2022, 11(4): 1195‐1214. DOI: 10.1007/s40122‐022‐ 00410‐z.

［42］ Correa‐Illanes G, Roa R, Piñeros JL, et al. Use of 5% lidocaine medicated plaster to treat localized neuropathic pain secondary to traumatic injury of peripheral nerves［J］. Local Reg Anesth, 2012, 5: 47‐53. DOI: 10.2147/LRA.S31868.

［43］ Xiao H, Ma K, Huang D, et al. Expert consensus of the ChineseAssociation for the Study of Pain on ion channel drugs for neuropathic pain［J］. World J Clin Cases, 2021, 9(9): 2100‐2109. DOI: 10.12998/wjcc.v9.i9.2100.

［44］ 中华医学会疼痛学分会 . 脊柱退变性神经根疼痛治疗专家共 识［J］. 中华医学杂志, 2019, 99(15): 1133‐1137. DOI: 10.3760/ cma.j.issn.0376‐2491.2019.15.003.

［45］ 乔长峰, 杨振玲, 陈景涛, 等 . 硬膜外注射地塞米松棕榈酸酯治 疗神经根型颈椎病的临床研究［J］. 实用疼痛学杂志, 2013, 9 (2): 109‐112. DOI: 10.3969/j.issn.1672‐9633.2013.02.007.

［46］ Davari M, Amani B, Amani B, et al. Pregabalin and gabapentin in neuropathic pain management after spinal cord injury: a systematic review and meta‐analysis［J］. Korean J Pain, 2020, 33 (1): 3‐12. DOI: 10.3344/kjp.2020.33.1.3.

［47］ Asgardoon MH, Jazayeri SB, Behkar A, et al. Pharmacologic therapies of pain in patients with spinal cord injury: a systematic review［J］. Spinal Cord Ser Cases, 2022, 8(1): 65. DOI: 10.1038/ s41394‐022‐00529‐3.

［48］ Tong C, Zhengyao Z, Mei L, et al. Pregabalin and gabapentin in patients with spinal cord injury‐related neuropathic pain: a network meta‐analysis［J］. Pain Ther, 2021, 10(2): 1497‐1509. DOI: 10.1007/s40122‐021‐00302‐8.

［49］ Mei L, Fengqun M, Zhengyao Z, et al. Efficacy and safety of different drug treatments in patients with spinal‐cord injury‐related neuropathic pain: a network meta‐analysis［J］. Spinal Cord, 2022, 60(11): 943‐953. DOI: 10.1038/s41393‐022‐ 00804‐y.

［50］ Onakpoya IJ, Thomas ET, Lee JJ, et al. Benefits and harms of pregabalin in the management of neuropathic pain: a rapid review and meta‐analysis of randomised clinical trials［J］. BMJ Open, 2019, 9(1): e023600. DOI: 10.1136/bmjopen‐2018‐023600.

［51］ Canavan C, Inoue T, McMahon S, et al. The efficacy, adverse events, and withdrawal rates of the pharmacological management of chronic spinal cord injury pain: a systematic review and meta‐analysis［J］. Pain Med, 2022, 23(2): 375‐395. DOI: 10.1093/ pm/pnab140.

［52］ Ling HQ, Chen ZH, He L, et al. Comparative efficacy and safety of 11 drugs as therapies for adults with neuropathic pain after spinal cord injury: a Bayesian network analysis based on 20 randomized controlled trials［J］. Front Neurol, 2022, 13: 818522. DOI: 10. 3389/fneur.2022.818522.

［53］ Ushida T, Katayama Y, Hiasa Y, et al. Mirogabalin for central neuropathic pain after spinal cord injury: a randomized, double‐blind, placebo‐controlled, phase 3 study in Asia ［J］. Neurology, 2023, 100(11): e1193‐e1206. DOI: 10.1212/WNL. 000 0000000201709.

［54］ Olusanya A, Yearsley A, Brown N, et al. Capsaicin 8% patch for spinal cord injury focal neuropathic pain, a randomized controlled trial［J］. Pain Med, 2023, 24(1): 71‐78. DOI: 10.1093/pm/pnac 104.

［55］ Han ZA, Song DH, Oh HM, et al. Botulinum toxin type A for neuropathic pain in patients with spinal cord injury［J］. AnnNeurol, 2016, 79(4): 569‐78. DOI: 10.1002/ana.24605.

［56］ Li G, Lv CA, Tian L, et al. A randomized controlled trial of botulinum toxin A for treating neuropathic pain in patients with spinal cord injury［J］. Medicine (Baltimore), 2017, 96(20): e6919. DOI: 10.1097/MD.0000000000006919.

［57］ Kumru H, Benito‐Penalva J, Kofler M, et al. Analgesic effect of intrathecal baclofen bolus on neuropathic pain in spinal cord injury patients［J］. Brain Res Bull, 2018, 140: 205‐211. DOI: 10. 1016/j.brainresbull.2018.05.013.

［58］ Nikles J, Keijzers G, Mitchell G, et al. Pregabalin vs placebo to prevent chronic pain after whiplash injury in at‐risk individuals: results of a feasibility study for a large randomised controlled trial ［J］. Pain, 2022, 163(2): e274‐e284. DOI: 10.1097/j.pain.0000000 000002362.

［59］ Zhao D, Chen Z, Hu S, et al. Efficacy and safety of loxoprofen hydrogel transdermal patch versus loxoprofen tablet in Chinese patients with myalgia: a double‐blind, double‐dummy, parallel‐group, randomized, controlled, non‐inferiority trial［J］. Clin Drug Investig, 2019, 39(4): 369‐377. DOI: 10.1007/s40261‐ 019‐00756‐x.

［60］ Shi C, Ye Z, Shao Z, et al. Multidisciplinary guidelines for the rational use of topical non‐steroidal anti‐inflammatory drugs for musculoskeletal pain (2022)［J］. J Clin Med, 2023, 12(4): 1544. DOI: 10.3390/jcm12041544.

［61］ Freo U, Ruocco C, Valerio A, et al. Paracetamol: a Review of Guideline Recommendations［J］. J Clin Med, 2021, 10(15): 3420. DOI: 10.3390/jcm10153420.

［62］ Hans G, Joukes E, Verhulst J, et al. Management of neuropathic pain after surgical and non‐surgical trauma with lidocaine 5% patches: study of 40 consecutive cases［J］. Curr Med Res Opin, 2009, 25(11): 2737‐2743. DOI: 10.1185/03007990903282297.

［63］ 史光耀, 张文安, 董建文, 等 . 活血止痛软胶囊治疗慢性软组织 (气滞血瘀证)损伤多中心临床研究［J］. 中国民间疗法, 2018, 26 (13): 30‐32. DOI: 10.19621/j.cnki.11‐3555/r.2018.1318.

［64］ 国家药品监督管理局网站 . 2021年度药品审评报告：https://www. nmpa.gov.cn/xxgk/fgwj/gzwj/gzwjyp/20220601110541120.html.

［65］ 中国老年保健协会 . 肌肉骨骼慢性疼痛诊治专家共识［J］. 骨 科, 2021,12(5): 389‐395. DOI: 10.3969/j.issn.1674‐8573.2021.05. 001.

［66］ 魏巍, 朱盈俊, 高国东 . 汉防己甲素片联合双氯芬酸钠片治疗 骨关节炎的疗效及安全性对照研究［J］. 中国基层医药, 2018, 25(13): 1724‐1728. DOI: 10.3760/cma. j. issn. 1008‐6706.2018. 13.024.

［67］ 李冬, 董晓俊, 程浩, 等 . 复方伤痛胶囊治疗创伤性膝滑膜炎 35 例［J］. 中国中医骨伤科杂志, 2016, 24(9): 22‐24.

［68］ 张振聪, 毛德荣, 张丽丽 . 复方伤痛胶囊促进骨折愈合临床疗 效 观 察［J］. 当 代 医 学 , 2018, 24(4): 29‐31. DOI: 10.3969/j.issn. 1009‐4393.2018.04.012.

［69］ Bonifácio de Assis ED, Martins WKN, de Carvalho CD, et al. Effects of rTMS and tDCS on neuropathic pain after brachial plexus injury: a randomized placebo‐controlled pilot study［J］. SciRep, 2022, 12(1): 1440. DOI: 10.1038/s41598‐022‐05254‐3.

［70］ Yang Y, Tang Y, Qin H, et al. Efficacy of transcutaneous electrical nerve stimulation in people with pain after spinal cord injury: a meta‐analysis［J］. Spinal Cord, 2022, 60(5): 375‐381. DOI: 10. 1038/s41393‐022‐00776‐z.

［71］ Kannan P, Bello UM, Winser SJ. Physiotherapy interventions may relieve pain in individuals with central neuropathic pain: a systematic review and meta‐analysis of randomised controlled trials ［J］. Ther Adv Chronic Dis, 2022, 13: 20406223221078672. DOI: 10.1177/20406223221078672.

［72］ Li L, Huang H, Yu Y, et al. Non‐invasive brain stimulation for neuropathic pain after spinal cord injury: a systematic review and network meta‐analysis ［J］. Front Neurosci, 2022, 15: 800560. DOI: 10.3389/fnins.2021.800560.

［73］ Mehta S, Orenczuk K, McIntyre A, et al. Neuropathic pain post spinal cord injury part 1: systematic review of physical and behavioral treatment［J］. Top Spinal Cord Inj Rehabil, 2013, 19 (1): 61‐77. DOI: 10.1310/sci1901‐61.

［74］ Saleh C, Ilia TS, Jaszczuk P, et al. Is transcranial magnetic stimulation as treatment for neuropathic pain in patients with spinal cord injury efficient? A systematic review［J］. Neurolsci, 2022, 43(5): 3007‐3018. DOI: 10.1007/s10072‐022‐05978‐0.

［75］ Todd KR, Lawrason SVC, Shaw RB, et al. Physical activity interventions, chronic pain, and subjective well‐being among persons with spinal cord injury: a systematic scoping review［J］. Spinal Cord, 2021, 59(2): 93‐104. DOI: 10.1038/s41393‐020‐ 00550‐z.

［76］ Zhang YH, Hu HY, Xiong YC, et al. Exercise for neuropathic pain: a systematic review and expert consensus［J］. Front Med (Lausanne), 2021, 8: 756940. DOI: 10.3389/fmed. 2021.756940.

［77］ Leung A, Shirvalkar P, Chen R, et al. Transcranial magnetic stimulation for pain, headache, and comorbid depression: ins‐nans expert consensus panel review and recommendation ［J］. Neuromodulation, 2020, 23(3): 267‐290. DOI: 10.1111/ner.13094.

［78］ Li X, Lu T, Yu H, et al. Repetitive transcranial magnetic stimulation for neuropathic pain and neuropsychiatric symptoms in traumatic brain injury: a systematic review and Meta‐analysis［J］. Neural Plast, 2022, 2022: 2036736. DOI: 10.1155/2022/2036736.

［79］ Choi GS, Kwak SG, Lee HD, et al. Effect of high‐frequency repetitive transcranial magnetic stimulation on chronic central pain after mild traumatic brain injury: a pilot study［J］. J Rehabil Med, 2018, 50(3): 246‐252. DOI: 10.2340/16501977‐2321.

［80］ Leung A, Shukla S, Fallah A, et al. Repetitive transcranial magnetic stimulation in managing mild traumatic brain injury‐related headaches ［J］. Neuromodulation, 2016, 19(2): 133‐41. DOI: 10.1111/ner.12364.

［81］ Ablin JN, Lang E, Catalogna M, et al. Hyperbaric oxygen therapy compared to pharmacological intervention in fibromyalgia patients following traumatic brain injury: a randomized, controlled trial［J］. PLoS One, 2023, 18(3): e0282406. DOI: 10.1371/journal. pone. 0282406.

［82］ Landén Ludvigsson M, Peterson G, Peolsson A. Neck‐specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash‐analyses of a randomized clinical trial ［J］. Sci Rep, 2018, 8(1): 12409. DOI: 10.1038/s41598‐018‐ 30556‐w.

［83］ Ludvigsson ML, Peterson G, Peolsson A. Neck‐specific exercise for radiating pain and neurological deficits in chronic whiplash, a 1‐year follow‐up of a randomised clinical trial［J］. Sci Rep, 2020, 10(1): 6758. DOI: 10.1038/s41598‐020‐62722‐4.

［84］ Chrcanovic B, Larsson J, Malmström EM, et al. Exercise therapy for whiplash‐associated disorders: a systematic review and meta‐analysis［J］. Scand J Pain, 2021, 22(2): 232‐261. DOI: 10. 1515/sjpain‐2021‐0064.

［85］ Kretzschmar M, Reining M, Schwarz MA. Three‐year outcomes after dorsal root ganglion stimulation in the treatment of neuropathic pain after peripheral nerve injury of upper and lower extremities［J］. Neuromodulation, 2021, 24(4): 700‐707. DOI: 10. 1111/ner.13222.

［86］ Helm S, Shirsat N, Calodney A, et al. Peripheral nerve stimulation for chronic pain: a systematic review of effectiveness and safety［J］. Pain Ther, 2021, 10(2): 985‐1002. DOI: 10.1007/s40122‐021‐ 00306‐4.

［87］ Curatolo M. Pharmacological and interventional management of pain after whiplash injury［J］. J Orthop Sports Phys Ther, 2016, 46 (10): 845‐850. DOI: 10.2519/jospt.2016.6906.

［88］ Lord SM, Barnsley L, Wallis BJ, et al. Chronic cervical zygapophysial joint pain after whiplash. A placebo‐controlled prevalence study［J］. Spine (Phila Pa 1976), 1996, 21(15): 1737‐ 1744; discussion 1744‐5. DOI: 10.1097/00007632‐199608010‐ 00005.

［89］ Gillum M, Huang S, Kuromaru Y, et al. Nonpharmacologic management of procedural pain in pediatric burn patients: a systematic review of randomized controlled trials［J］. J Burn Care Res, 2022, 43(2): 368‐373. DOI: 10.1093/jbcr/irab167.

［90］ Garrido‐Ardila EM, Santos‐Domínguez M, Rodríguez‐Mansilla J, et al. A systematic review of the effectiveness of virtual reality‐based interventions on pain and range of joint movement associated with burn injuries［J］. J Pers Med, 2022, 12(8): 1269. DOI: 10.3390/jpm12081269.

［91］ Norouzkhani N, Chaghian Arani R, Mehrabi H, et al. Effect of virtual reality‐based interventions on pain during wound care in burn patients; a systematic review and meta‐analysis ［J］. Arch Acad Emerg Med, 2022, 10(1): e84. DOI: 10.22037/aaem. v10i1. 1756.

［92］ Provençal SC, Bond S, Rizkallah E, et al. Hypnosis for burn wound care pain and anxiety: a systematic review and meta‐analysis［J］. Burns, 2018, 44(8): 1870‐1881. DOI: 10.1016/j. burns. 2018.04. 017.

［93］ 马惠珍, 张娟, 姚苗, 等 . 芳香疗法对成人烧伤病人疼痛程度、 焦虑情绪和睡眠状态影响的 Meta 分析［J］. 循证护理, 2022, 8 (24): 3303‐3307. DOI: 10.12102/j.issn.2095‐8668.2022.24.006.

［94］ Chi B, Chau B, Yeo E, et al. Virtual reality for spinal cord injury‐associated neuropathic pain: systematic review［J］. Ann Phys Rehabil Med, 2019, 62(1): 49‐57. DOI: 10.1016/j.rehab.2018. 09.006.

［95］ Tran Y, Austin P, Lo C, et al. An exploratory EEG analysis on the effects of virtual reality in people with neuropathic pain following spinal cord injury［J］. Sensors (Basel), 2022, 22(7): 2629. DOI: 10. 3390/s22072629.

［96］ Burke D, Lennon O, Blake C, et al. An internet‐delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: a randomized controlled trial［J］. Eur J Pain, 2019, 23(7): 1264‐1282. DOI: 10.1002/ejp.1402.

［97］ Hearn JH, Cross A. Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review ［J］. BMC Neurol, 2020, 20(1): 32. DOI: 10.1186/s12883‐020‐ 1619‐5.

［98］ Hearn JH, Finlay KA. Internet‐delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial［J］. Spinal Cord, 2018, 56 (8): 750‐761. DOI: 10.1038/s41393‐018‐0090‐2.

［99］ Zanca JM, Gilchrist C, Ortiz CE, et al. Pilot clinical trial of a clinical meditation and imagery intervention for chronic pain after spinal cord injury［J］. J Spinal Cord Med, 2022, 45(3): 339‐353. DOI: 10.1080/10790268.2021.1970894.

［100］Wood C, Cutshall SM, Lawson DK, et al. Music therapy for anxiety and pain after spinal cord Injury: a pilot study［J］. Glob Adv Health Med, 2021, 10: 21649561211058697. DOI: 10.1177/ 21649561211058697.

［101］He K, Hu R, Huang Y, et al. Effects of acupuncture on neuropathic pain induced by spinal cord injury: a systematic review and meta‐analysis［J］. Evid Based Complement Alternat Med, 2022, 2022: 6297484. DOI: 10.1155/2022/6297484.

［102］Varma A, Naqvi WM, Mulla S, et al. A systematic review of randomized controlled trials on virtual reality application in pediatric patients［J］. Cureus, 2022, 14(10): e30543. DOI: 10. 7759/cureus.30543.

［103］Sodders MD, Martin AM, Coker J, et al. Acupuncture use for pain after traumatic brain injury: a NIDILRR traumatic brain injury model systems cohort study［J］. Brain Inj, 2023, 37(6): 494‐502.DOI: 10.1080/02699052.2023.2187088.

［104］Andersen TE, Ravn SL, Mejldal A, et al. Values‐based cognitive behavioural therapy for the prevention of chronic whiplash associated disorders: a randomized controlled trial［J］. Eur J Pain, 2022, 26(6): 1256‐1268. DOI: 10.1002/ejp.1945.

［105］Langlois P, Perrochon A, David R, et al. Hypnosis to manage musculoskeletal and neuropathic chronic pain: a systematic review and meta‐analysis［J］. Neurosci Biobehav Rev, 2022, 135: 104591. DOI: 10.1016/j.neubiorev.2022.104591.

［106］刘芮村, 倪兵, 胡永生, 等 . 脊髓背根入髓区毁损术治疗臂丛神 经损伤后神经病理性疼痛的疗效及其影响因素分析(附 105 例 报 告)［J］. 中 华 神 经 外 科 杂 志 , 2020, 36(4): 385‐389. DOI: 10. 3760/cma.j.cn112050‐20191010‐00429.

［107］Mehta S, Orenczuk K, McIntyre A, et al. Neuropathic pain post spinal cord injury part 2: systematic review of dorsal root entry zone procedure［J］. Top Spinal Cord Inj Rehabil, 2013, 19(1): 78‐86. DOI: 10.1310/sci1901‐78.

［108］Nyström B, Svensson E, Larsson S, et al. A small group Whiplash‐Associated‐Disorders (WAD) patients with central neck pain and movement induced stabbing pain, the painful segment determined by mechanical provocation: fusion surgery was superior to multimodal rehabilitation in a randomized trial［J］. Scand J Pain, 2016, 12: 33‐42. DOI: 10.1016/j. sjpain. 2016.03. 003.