Promoting Gait Recovery and Limiting Neuropathic Pain After Spinal Cord Injury: Two Sides of the Same Coin?

Neurorehabilitation and Neural Repair, 2017 · DOI: 10.1177/1545968316680491 · Published: April 1, 2017

Spinal Cord Injury Pain Management Rehabilitation

Simple Explanation

This article addresses the disconnect between basic science findings and rehabilitation research regarding pain and gait rehabilitation after spinal cord injury (SCI). Basic research suggests that central sensitization (maladaptive plasticity) and motor learning (adaptive plasticity) share neural mechanisms and compete. The article explores interactions between nociception and learning in the spinal cord, the applicability of animal model findings to humans, and the consideration of these interactions in clinical research. Animal studies reveal that nociceptive input can impair motor learning, while motor learning can influence nociception and pain perception. Specifically, uncontrollable noxious stimuli interfere with motor recovery after SCI. Conversely, motor training can prevent or reverse tactile hyperreactivity, a sign of central sensitization. Clinical research often overlooks the interaction between pain and motor learning in SCI rehabilitation, which can affect the validity of study results. Many clinical trials exclude patients with significant pain, limiting the generalizability of the findings. Future research should integrate pain assessment and management into gait retraining studies.

Study Duration

Not specified

Participants

Persons living with spinal cord injury

Evidence Level

Not specified

Key Findings

1
Nociceptive input can have long-term effects on motor recovery after spinal cord injury by modulating the ability of the spinal cord to learn.
2
Early motor training can prevent the development of tactile hyperreactivity.
3
Tonic pain experienced during locomotor training impairs retention despite normal performance during acquisition.

Research Summary

The article addresses the discrepancy between basic science and clinical research regarding the interaction of pain and motor recovery after spinal cord injury (SCI). It highlights that while animal studies demonstrate significant interactions between nociception and motor learning, these interactions are often overlooked in human rehabilitation research. Animal studies show that nociceptive input can impair motor learning, and conversely, motor learning can reduce pain and tactile hyperreactivity. Human studies confirm that pain can interfere with locomotor learning, but the impact of motor training on central sensitization in humans remains largely unexplored. Current clinical research often neglects pain in lower-limb intervention studies, leading to internal and external validity issues. The authors recommend that future studies include patients with pain, document pain adequately, and consider neuromodulation strategies to mitigate the negative impact of pain on motor learning.

Practical Implications

Integrate Pain Assessment in Clinical Trials

Clinical trials should incorporate comprehensive pain assessments before, during, and after interventions to understand the impact of pain on motor recovery and vice versa.

Consider Neuromodulation Strategies

Explore neuromodulation techniques to mitigate the negative effects of pain on motor learning during rehabilitation.

Include Patients with Pain in Studies

Ensure that clinical trials include individuals with pain to enhance the external validity and generalizability of research findings.

Study Limitations

1
The instrumental learning paradigm used in most animal studies is very different from locomotor training performed in rehabilitation.
2
The experimental pain model employed (and particularly uncontrollable electrical stimulation) is difficult to relate to what is experienced by patients with SCI.
3
Assessing the perception of pain is impossible in animal models, and examining behavioral evidence of nociception is still very difficult.

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