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Pain with syringomyelia
Last reviewed: 23.04.2024
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Syringomyelia is characterized by disorders of pain sensitivity leading to hypoesthesia and so-called painless burns. At the same time, pain syndrome with syringomyelia is noted in 50-90% of patients. The clinical characteristics of pain are very variable. Some patients complain of pain in the radicular nature in the hands, pain in the interblade area, sometimes in the back. In 40% of patients noted dysesthesia, burning painful yuli. Characteristic of hyperesthesia and allodynia in the hands, along with hypotrophy and vegetative-trophic disorders.
The pathogenesis of pain with syringomyelia is associated with a violation of sensory balance in the thermoregulatory system, as well as with disinhibition. There are data on the pathology of neurotransmitters in the spinal cord [excessive content of substance P and deficiency of y-aminobutyric acid (GABA) in hind legs]. Based on the results of recent studies using functional MRI, it is suggested that central neuropathic pain in this disease can not be regarded simply as an enhancement of normal nociceptive afferentation. There is no direct correlation between the degree of reduction in sensitivity and the intensity of pain. It is shown that different clinical manifestations of neuropathic pain (spontaneous pains, different types of allodynia, etc.) are associated with different pathophysiological mechanisms, which is important from the point of view of carrying out differentiated therapy.
Treatment of neuropathic pain with syringomyelia is a difficult task. Controlled studies on the use of pharmacological drugs have not yet been conducted. A rational combined pharmacotherapy (antidepressants combined with anticonvulsants, local anesthetics and opioids) is desirable.
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