Neuropathic Pain Post Spinal Cord Injury Part 2: Systematic Review of Dorsal Root Entry Zone Procedure

Top Spinal Cord Inj Rehabil, 2013 · DOI: 10.1310/sci1901-78 · Published: January 1, 2013

Spinal Cord Injury Pain Management Surgery

Simple Explanation

Neuropathic pain following spinal cord injury can significantly impair daily life, leading to issues like social isolation and reduced quality of life. Current treatments such as medication may not always be effective. When medication and noninvasive treatments don't work, surgical options like dorsal root entry zone (DREZ) ablation can be considered to manage pain. This systematic review examines the effectiveness of DREZ ablation therapies in reducing neuropathic pain in individuals following SCI.

Study Duration

Not specified

Participants

Eleven studies with sample sizes ranging from 6 to 56

Evidence Level

One study provided level 2 evidence, and the rest provided level 4 evidence

Key Findings

1
The DREZ procedure appears to be more effective for segmental pain than for diffuse pain after SCI.
2
Individuals with conus medullaris level injury reported higher rates of pain relief compared to those with cervical, thoracic, or cauda equina injuries.
3
Studies suggest extending the DREZ procedure into the irritative zone may improve relief of diffuse pain.

Research Summary

This systematic review evaluated eleven studies on the effectiveness of the DREZ procedure for neuropathic pain after SCI, finding that the DREZ procedure may be effective in reducing pain after SCI. The DREZ procedure appears more effective for segmental pain, and individuals with conus medullaris injuries reported higher pain relief. Larger controlled trials are needed to further assess the efficacy of DREZ, utilizing standardized pain outcome measures and quality of life assessments.

Practical Implications

Treatment Option

DREZ procedure may be considered as a treatment option for neuropathic pain in individuals with SCI who are resistant to less invasive treatments.

Targeted Approach

The procedure is most effective for individuals with segmental pain or injuries at the conus medullaris level.

Further Research

Future studies should focus on controlled trials and the inclusion of standardized outcome measures for pain and quality of life.

Study Limitations

1
Most studies lacked control groups or conditions and were primarily observational convenience samples.
2
The quality of the studies reviewed was a significant limitation; all but one provided level 4 evidence.
3
There is a well-known and important publication bias, since studies with positive findings are more likely to be published.

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