An unusual presentation of neuropathic pain following cervical spinal cord injury: a case report

BMC Neurology, 2020 · DOI: https://doi.org/10.1186/s12883-020-01644-0 · Published: February 12, 2020

Spinal Cord Injury Neurology Pain Management

Simple Explanation

This case report describes a patient who experienced severe occipital (back of the head) pain after a cervical spinal cord injury (SCI). This type of pain, known as at-level neuropathic pain, is unusual in its location following such an injury. The patient's pain was characterized as tingling, burning, and piercing, with increased sensitivity to touch in the affected area. Standard treatments like nerve blocks did not provide relief. MRI revealed a small injury in the central part of the spinal cord at the C2 level. After medication, the patient's pain decreased significantly.

Study Duration

Not specified

Participants

One 50-year-old male

Evidence Level

Level 4: Case Report

Key Findings

1
The patient experienced severe bilateral occipital pain (at-level neuropathic pain) due to a small central cervical SCI, which is an unusual presentation.
2
MRI showed a focal high signal change in the central portion of the spinal cord at the C2 level, indicating the site of injury.
3
Oral medications, including pregabalin, tramadol/acetaminophen, and buprenorphine, were effective in reducing the patient's pain from a numeric rating scale (NRS) score of 9 to 2.

Research Summary

This case report details a 50-year-old man who developed severe bilateral occipital pain following a fall that resulted in a small central cervical spinal cord injury (SCI) at the C2 level. The patient's pain was neuropathic in nature, described as tingling, burning, and piercing, with hyperalgesia in the posterior head regions. Initial treatment with a greater occipital nerve block was ineffective. After administration of oral medications, including pregabalin, tramadol/acetaminophen, and buprenorphine, the patient experienced a significant reduction in pain. The case highlights the variability of neuropathic pain presentation following SCI.

Practical Implications

Diagnostic Awareness

Clinicians should be aware of the possibility of unusual pain presentations, such as occipital neuropathic pain, following cervical spinal cord injuries, even in the absence of significant motor deficits.

Imaging Importance

MRI is crucial in identifying the location and extent of spinal cord injuries that may be causing neuropathic pain.

Personalized Treatment

A combination of medications, such as pregabalin, tramadol/acetaminophen, and buprenorphine, may be effective in managing neuropathic pain following SCI, but treatment plans should be tailored to the individual patient's needs.

Study Limitations

1
Single case report limits generalizability.
2
Lack of long-term follow-up to assess the durability of the treatment effect.
3
The specific mechanism of injury leading to the unusual pain presentation is not fully elucidated.

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