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Syringomyelia pain
Last reviewed: 07.07.2025
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Syringomyelia is characterized by pain sensitivity disorders leading to hypoesthesia and so-called painless burns. At the same time, pain syndrome in syringomyelia is noted in 50-90% of patients. Clinical characteristics of pain are very variable. Some patients complain of radicular pain in the arms, pain in the interscapular region, and sometimes in the back. Dysesthesia, burning, excruciating pain, are noted in 40% of patients. Hyperesthesia and allodynia in the arms are characteristic, along with hypotrophy and vegetative-trophic disorders.
The pathogenesis of pain in syringomyelia is associated with a disturbance of sensory balance in the thermoregulatory system, as well as with disinhibition. There is evidence of pathology of neurotransmitters in the spinal cord [excessive content of substance P and deficiency of γ-aminobutyric acid (GABA) in the dorsal horns]. Based on the results of recent studies using functional MRI, it has been suggested that central neuropathic pain in this disease cannot be considered simply as an increase in normal nociceptive afferentation. There is no direct correlation between the degree of sensitivity reduction and pain intensity. It has been shown that different clinical manifestations of neuropathic pain (spontaneous pain, various types of allodynia, etc.) are associated with different pathophysiological mechanisms, which is important from the point of view of differentiated therapy.
Treatment of neuropathic pain in syringomyelia is a complex task. Controlled studies on the use of pharmacological drugs have not yet been conducted. Rational combination pharmacotherapy (antidepressants in combination with anticonvulsants, local anesthetics and opioids) is advisable.
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