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Pain in spinal cord injuries
Last reviewed: 23.04.2024
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In 27-94% of patients with spinal trauma chronic moderate or severe pain is noted. It is believed that in 30% of patients the pain by nature is predominantly central to the neuropathic. The reasons for the formation of a pain syndrome after a spinal cord injury are not fully understood. Neuropathic pain after spinal trauma is most often characterized by patients as "pinching", "tingling", "shooting", "exhausting", "pulling", "irritating", "burning", "shooting", "like electric shock". Pain can be localized, one-sided or diffuse bilateral, capturing the area below the lesion level. Often especially intense pain in the perineum. Against this background, there may be different in nature paroxysmal focal and diffuse pain. An unusual pattern of reflected pain is described in patients with partial lesion of the spinal cord (its anterolateral regions): when pain and temperature stimuli are applied in the area of sensation loss, the patient senses them in appropriate zones contralaterally on the healthy side. This phenomenon was called "allochuria" ("the other hand"). Along with full or partial paresis, often accompanying spinal cord trauma, in many patients the pain has no less negative impact on the level of physical activity and quality of life. According to a recently published study, 27% of patients with post-traumatic pain syndrome rated pain intensity as strong, and 90% of them considered pain to be an important negative factor in daily life.
Treatment of pain in spinal cord injuries. Apply pharmacotherapy, physiotherapy, surgical treatment, psychological rehabilitation. At present, there is no convincing evidence from evidence studies that could be ready for treatment. In preliminary studies, the effectiveness of intravenous infusions of lidocaine, cannabinoids, lamotrigine, ketamine has been shown, but unwanted side reactions often occurred. In several placebo-controlled studies, gabapentin has been shown to be effective (1800-2400 mg / day for 8-10 weeks), which is considered the first line treatment for the treatment of neuropathic pain caused by spinal cord trauma. There are also data on the efficacy of pregabalin (150-600 mg / day).
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