Spinal cord injury pain

Chronic moderate or severe pain is noted in 27-94% of patients with spinal cord injury. It is believed that 30% of patients have pain of a predominantly central neuropathic nature. The causes of pain syndrome formation after spinal cord injury are not fully understood. Neuropathic pain after spinal cord injury is most often characterized by patients as "pinching", "tingling", "shooting", "exhausting", "pulling", "irritating", "burning", "shooting", "like an electric shock". The pain can be localized, unilateral or diffuse bilateral, affecting the area below the level of injury. Pain in the perineum area often becomes particularly intense. Against this background, paroxysmal focal and diffuse pain of various natures can occur. An unusual pattern of referred pain has been described in patients with partial spinal cord injury (its anterolateral parts): when pain and temperature stimuli are applied to the area of sensory loss, the patient feels them in the corresponding zones contralaterally on the healthy side. This phenomenon is called "allocheiria" ("other hand"). Along with complete or partial paresis, which often accompanies spinal cord injury, pain has an equally negative impact on the level of physical activity and quality of life in many patients. According to a recently published study, 27% of patients with post-traumatic pain syndrome rated the pain intensity as severe, and 90% of them consider pain to be an important negative factor in everyday life.

Treatment of pain in spinal cord injuries. Pharmacotherapy, physical therapy, surgical treatment, psychological rehabilitation are used. At present, there is no convincing data obtained in evidence-based studies that could be ready-made recommendations for treatment. Preliminary studies have shown the effectiveness of intravenous infusions of lidocaine, cannabinoids, lamotrigine, ketamine, but undesirable side effects often occurred. Several placebo-controlled studies have shown the effectiveness of gabapentin (1800-2400 mg / day for 8-10 weeks), which is considered a first-line drug for the treatment of neuropathic pain caused by spinal cord injury. There is also data on the effectiveness of pregabalin (150-600 mg / day).

[ 1 ], [ 2 ], [ 3 ], [ 4 ]