Individuals With Prior Chronic Pain and Long-Term Opioid Treatment May Experience Persistence of That Pain Even After Subsequent Complete Cervical Spinal Cord Injury: Suggestions From a Prospective Case-Controlled Study

Archives of Rehabilitation Research and Clinical Translation, 2024 · DOI: https://doi.org/10.1016/j.arrct.2024.100338 · Published: January 1, 2024

Spinal Cord Injury Pain Management

Simple Explanation

This study investigates whether chronic pain persists after a complete spinal cord injury (SCI), focusing on patients who had chronic pain before their injury. The research found that some patients with pre-existing chronic pain continued to experience that pain even after complete tetraplegia, especially if they had been treated with opioids. The findings suggest that certain types of chronic pain may be based in the brain and maintained by opioid use, irrespective of peripheral pain signals.

Study Duration

3 Years

Participants

7 participants with prior chronic pain and acute cervical SCI

Evidence Level

Prospective observational study

Key Findings

1
Four out of seven participants with prior chronic pain continued to experience the same pain after complete tetraplegia.
2
All participants who experienced continued pain after SCI had been previously treated with long-term opioids.
3
The patients whose pain ceased after SCI had not received chronic opioid therapy.

Research Summary

The study prospectively examined patients with prior chronic pain who suffered an acute complete spinal cord injury (SCI) to determine if the pre-existing pain persisted, changed, and whether opioids had any effect. The primary outcome measured chronic pain before complete SCI compared with its continuation after SCI, while the secondary outcome was opioid use. The study concluded that there may be a unique form of chronic pain that is based in the brain, irrespective of peripheral pain or spinal mechanisms, and that opioids may be requisite for this type of pain.

Practical Implications

New Model for Brain-Based Pain Evaluation

The study suggests a new model for evaluating brain-based pain isolated from the original source, which could be useful for neuroscientists.

Rethinking Opioid Use in Chronic Pain

The finding that opioids may maintain chronic pain rather than alleviating it may lead to new treatments for acute and chronic intractable pain.

Expanded Perspective on Peripheral Pain

The idea that seemingly peripheral pain may be localized to the brain could benefit primary care physicians and others who treat chronic pain.

Study Limitations

1
Small sample size prevented meaningful statistical analysis.
2
Reliance on clinical diagnosis of complete SCI without objective tests.
3
Lack of long-term outcomes for all patients due to death or lack of follow-up.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury