CHRONIC PAIN FOLLOWING SPINAL CORD INJURY

Adv Exp Med Biol, 2012 · DOI: · Published: January 1, 2012

Spinal Cord Injury Neurology Pain Management

Simple Explanation

Many individuals who experience spinal cord or central nervous system damage suffer from severe, persistent, chronic pain that does not respond well to treatment. This problem affects many spinal cord injury patients, as well as those with multiple sclerosis, stroke, and other conditions. The pathophysiological mechanisms of pain following spinal cord injury remain unknown. However, the study describes a novel mechanism of loss of inhibition within the thalamus that may predispose for the development of this chronic pain. The zona incerta (ZI) is a unique source of inhibition to the thalamus, and the study has demonstrated that spontaneous firing rates and somatosensory evoked responses of ZI neurons are lower in animals with spinal cord injury compared to sham-operated controls.

Study Duration

Not specified

Participants

259,000 people in the United States suffer from spinal cord injury

Evidence Level

Not specified

Key Findings

1
Localized electrolytic lesions in the anterolateral quadrant of the spinal cord in animal models result in consistent, long-lasting below- and above-level mechanical and thermal hyperalgesia.
2
Animals with spinal cord lesions develop a significant preference for an analgesic-paired chamber compared to a saline-paired chamber, indicating signs of tonic pain.
3
Abnormalities in the APT/incerto-thalamic system are causally related to maladaptive plasticity following spinal cord injury, and manipulation of this system may prove effective in ameliorating chronic neuropathic pain.

Research Summary

Chronic pain following spinal cord injury is a debilitating condition affecting many patients with central nervous system lesions or dysfunction. The underlying pathophysiological processes of chronic neuropathic pain are poorly understood, despite its discovery over a century ago. The study suggests that pain can result from suppressed inhibitory inputs from the zona incerta (ZI) and anterior pretectal nucleus (APT), leading to enhanced activity in the posterior nucleus (PO) of the thalamus and the primary somatosensory cortex (S1). The study concludes that manipulations that enhance activity in the ZI/APT and restore inhibition may be effective in treating spinal cord injury pain.

Practical Implications

Targeted Therapies

Developing therapies focused on enhancing activity in the zona incerta (ZI) and anterior pretectal nucleus (APT) to restore inhibitory function in the thalamus may offer a novel approach to managing chronic pain following spinal cord injury.

Motor Cortex Stimulation

Utilizing motor cortex stimulation (MCS) to modulate activity in the ZI and APT could provide a non-pharmacological method for pain relief in spinal cord injury patients, especially when optimized with effective stimulation parameters.

Personalized Treatment Strategies

Further research into the mechanisms of central pain and the role of specific brain structures like the ZI and APT can lead to more personalized and effective treatment strategies for individuals suffering from spinal cord injury pain.

Study Limitations

1
The pathophysiological processes underlying chronic neuropathic pain are poorly understood.
2
Current treatments for spinal cord injury pain are rarely consistently effective.
3
The study relies on animal models, which may not fully recapitulate the complexity of human chronic pain.

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