Walking with Neuropathic Pain: Paradoxical Shift from Burden to Support?

A 71-year-old woman with a spinal cord injury experienced neuropathic pain. Treatment with baclofen cream provided complete pain relief. However, this pain relief led to increased difficulty walking and more frequent falls. The patient's previous pain sensations were, paradoxically, helping her maintain balance and spatial awareness. Eliminating the pain through baclofen disrupted this compensatory mechanism. This case highlights that in some instances, neuropathic pain can become integrated into a patient's body schema, aiding in mobility and orientation, and its removal can negatively impact these functions.

• 1
  Topical baclofen 5% cream can effectively control neuropathic pain associated with spinal cord injury.
• 2
  Positive neuropathic symptoms (e.g., pain) can mask underlying sensory losses (e.g., numbness).
• 3
  Elimination of neuropathic pain can interfere with walking ability by unmasking sensory losses and disrupting compensatory mechanisms.