Evaluation of a Clinical Protocol to Assess and Diagnose Neuropathic Pain During Acute Hospital Admission Results From Traumatic Spinal Cord Injury

Clin J Pain, 2018 · DOI: 10.1097/AJP.0000000000000523 · Published: February 1, 2018

Spinal Cord Injury Pain Management Research Methodology & Design

Simple Explanation

This study aimed to assess the impact of a clinical protocol on the assessment and diagnosis of neuropathic pain (NP) in patients with traumatic spinal cord injury (SCI) during acute care. The study also sought to determine the incidence and onset of NP in this patient population. The Vancouver Acute Neuropathic Pain Treatment Guideline (VANPTG) was developed for clinicians to routinely assess acute patients for NP, prescribe initial treatment according to a clinical algorithm, and initiate a pain expert consultation. The study found a high incidence of NP in traumatic SCI patients during acute hospital care and demonstrated that the NP clinical protocol ensured continuous assessment and documentation of NP while decreasing the time to an initial screen.

Study Duration

Not specified

Participants

276 participants with traumatic spinal cord injury

Evidence Level

Level 3, cohort study with a pre-post-test utilizing a historical control

Key Findings

1
The incidence of NP was 56% in patients with traumatic SCI during acute hospital care.
2
The onset of NP was, on average, 8 days following injury, with the majority of cases diagnosed within the first two weeks.
3
The implementation of the NP clinical protocol decreased the time to initial assessment but did not significantly impact diagnosis or treatment.

Research Summary

This study evaluated the effectiveness of the Vancouver Acute Neuropathic Pain Treatment Guideline (VANPTG) in assessing and diagnosing neuropathic pain (NP) in patients with traumatic spinal cord injury (SCI) during acute hospital admission. The study found a high incidence (56%) and early onset (8 days) of NP in this population. The VANPTG improved assessment documentation and reduced the time to initial screening but did not significantly affect diagnosis or treatment. The study also revealed that patients with incomplete SCI experienced an earlier onset of NP compared to those with complete SCI, highlighting the importance of early assessment and documentation in this subgroup.

Practical Implications

Early Assessment of Incomplete SCI

Given the earlier onset of NP in patients with incomplete SCI, healthcare providers should prioritize early and frequent assessment for NP in this population.

Implementation of Clinical Protocols

Hospitals and SCI centers should consider implementing clinical protocols for NP assessment to improve documentation and ensure timely screening.

Education and Training

Healthcare professionals involved in the care of SCI patients should receive education and training on NP assessment, diagnosis, and management, especially in acute care settings.

Study Limitations

1
The study used retrospective data collected from hospital charts, which may have resulted in incomplete or missing information.
2
The absence of NP was not as meticulously recorded as the presence of NP, especially in cohort 1.
3
The gold standard of diagnosis by the pain experts has not been independently validated.

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