Central Neuropathic Pain in Spinal Cord Injury

Crit Rev Phys Rehabil Med, 2013 · DOI: 10.1615/CritRevPhysRehabilMed.2013007944 · Published: January 1, 2013

Spinal Cord Injury Neurology Pain Management

Simple Explanation

Spinal cord injury (SCI) can lead to a common complication called central neuropathic pain, which is difficult to treat. Current treatments include medications, exercise, acupuncture, and psychological approaches. To improve treatment, we need better ways to assess and classify this pain and a deeper understanding of its causes. A multidisciplinary approach to patient care, combined with a better understanding of the causes and diagnosis of SCI pain, will improve management and treatment. This article reviews classification tools, causes, and current treatment options for central neuropathic pain in SCI patients. Central neuropathic pain is a subcategory of neuropathic pain and is common in SCI. It can be defined as pain arising as a direct consequence of a lesion or a disease affecting the somatosensory system, in particular in the spinal cord and affecting the spinothal-amocortical pathways.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
The International Spinal Cord Injury Pain (ISCIP) classification organizes SCI pain into 3 tiers: type of pain, pain subtypes, and source of pain. This classification helps standardize communication and treatment approaches.
2
Central neuropathic pain after SCI involves anatomical, neurochemical, and inflammatory changes in the central nervous system. These changes lead to hyperexcitability of neurons and imbalances in pain pathways.
3
While various pharmacological agents like opioids, antiepileptics, and antispastics are used, their effectiveness for central neuropathic pain varies. Newer antiepileptics such as gabapentin and pregabalin show promise, but more research is needed.

Research Summary

Central neuropathic pain is a frequent and challenging complication following spinal cord injury (SCI). Effective management requires a comprehensive understanding of pain classification, pathophysiology, and treatment options. The International Spinal Cord Injury Pain (ISCIP) classification system provides a structured approach to categorizing SCI pain, facilitating communication and targeted treatment strategies. Understanding the underlying mechanisms of central neuropathic pain, including neurochemical and anatomical changes in the central nervous system, is crucial for developing effective therapies. Current treatment options include pharmacological interventions (e.g., opioids, antiepileptics, antispastics) and non-pharmacological approaches (e.g., exercise, acupuncture, psychological therapies). A multidisciplinary approach, combining pharmacological and non-pharmacological strategies, is recommended for optimal pain management in SCI patients.

Practical Implications

Improved Pain Assessment

Implement standardized pain assessment tools and classification systems (e.g., ISCIP) to accurately identify and categorize SCI-related pain.

Multidisciplinary Approach

Adopt a multidisciplinary approach involving physicians, therapists, psychologists, and other healthcare professionals to provide comprehensive pain management.

Personalized Treatment Plans

Develop personalized treatment plans based on individual patient characteristics, pain types, and responses to various interventions.

Study Limitations

1
Limited research on specific treatments for central neuropathic pain in SCI.
2
Variability in pain presentation and response to interventions among SCI patients.
3
Lack of large, placebo-controlled clinical trials for many non-pharmacological treatments.

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