About pain and its treatment in paraplegics

Maury, M

doi:10.1038/sc.1977.53

Cited by 20 publications

(7 citation statements)

References 3 publications

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“…Riddoch 1 classi®ed pain as local and remote, Michaelis 6 classi®ed pain as above, at and below lesion level and Maury 41 classi®ed pain as sublesional, lesional and supra-lesional. While classi®cation by location is simple and logically appealing, use of location to classify pain is problematic.…”

Section: Classi®cation By Region Of Painmentioning

confidence: 99%

Classification of pain following spinal cord injury

1997

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Pain continues to be a signi®cant management problem in people with spinal cord injuries. Despite this there is little consensus regarding the nature, terminology and de®nitions of the various types of pain that occur following spinal cord injury. This has led to large variations in the reported incidence and prevalence of pain following spinal cord injury. Treatment studies have been hampered by inconsistent and inaccurate identi®cation of pain types. We believe that both research and management would bene®t from an agreed upon classi®cation system which accurately and reliably identi®es the types of pain that occur following spinal cord injury. We have reviewed the literature on the classi®cation of pain following spinal cord injury and have developed a classi®cation system which adopts the strengths of previous systems and attempts to avoid the weaknesses inherent in others. Our proposed classi®cation system of pain following spinal cord injury includes four major divisions: musculoskeletal, visceral, neuropathic and other types of pain. We have divided neuropathic pain on the basis of region into two subdivisions: neuropathic at level and neuropathic below level pain. We have further divided neuropathic at level pain into two categories: radicular and central, to indicate the presumed site of the lesion responsible for pain generation. We believe that our proposed classi®cation system is comprehensive, simple and readily applicable in the clinical and research situation. It is our hope that this proposed classi®cation will contribute to the eventual development of a universal system for the classi®cation of pain following spinal cord injury.

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Section: Classi®cation By Region Of Painmentioning

confidence: 99%

Classification of pain following spinal cord injury

1997

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“…Neuropathic pain thought to be due to damage to the spinal cord and presenting topographically in the dermatomes below the damaged segments has been variously called spinal cord pain, phantom pain, diffuse pain, central remote pain, deafferentation pain, below level central pain and SCI pain. 5,[10][11][12][13][14][15] Such a confusion of number and nature of pain subtypes, and terms used, obviously impedes communication between clinicians, researchers and others. The authors agreed that it would be worthwhile to create a consensus classification based on international input and state-of-the-art basic and clinical scholarship.…”

Section: Introductionmentioning

confidence: 99%

International Spinal Cord Injury Pain Classification: part I. Background and description

et al. 2011

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Study design: Discussion of issues and development of consensus. Objective: Present the background, purpose, development process, format and definitions of the International Spinal Cord Injury Pain (ISCIP) Classification. Methods: An international group of spinal cord injury (SCI) and pain experts deliberated over 2 days, and then via e-mail communication developed a consensus classification of pain after SCI. The classification was reviewed by members of several professional organizations and their feedback was incorporated. The classification then underwent validation by an international group of clinicians with minimal exposure to the classification, using case study vignettes. Based upon the results of this study, further revisions were made to the ISCIP Classification. Results: An overall structure and terminology has been developed and partially validated as a merger of and improvement on previously published SCI pain classifications, combined with basic definitions proposed by the International Association for the Study of Pain and pain characteristics described in published empiric studies of pain. The classification is designed to be comprehensive and to include pains that are directly related to the SCI pathology as well as pains that are common after SCI but are not necessarily mechanistically related to the SCI itself. Conclusions:The format and definitions presented should help experienced and non-experienced clinicians as well as clinical researchers classify pain after SCI.

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“…epidural electrical stimulation [34]. cordectomy [28], rhizotomy [12], ablation of the dorsal root entry zone [29,36] and psychotropic medications [18,25]. Studies designed to evaluate the efficacy of these interventions have been limited by two fundamental methodologic flaws: these studies failed to precisely identify the types of pain syndromes under treatment and these protocols generally did not use reliable established measures of pain quality and intensity.…”

Section: Introductionmentioning

confidence: 99%

Trazodone hydrochloride in the treatment of dysesthetic pain in traumatic myelopathy: a randomized, double-blind, placebo-controlled study

Davidoff

Guarracini

Roth

et al. 1987

Pain

123

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Dysesthetic pain following traumatic myelopathy is characterized by diffuse burning and tingling sensations distal to the level of spinal injury. The dysesthetic pain syndrome (DPS) can compromise performance of functional abilities and inhibit participation in rehabilitation programs. Recent laboratory evidence suggests that antidepressant medications with selective inhibition of serotonin reuptake in the brain may be associated with superior analgesic effect compared to such non-selective agents as amitriptyline. Trazodone hydrochloride is a potent presynaptic serotonin reuptake blocker with few anticholinergic and cardiovascular side effects. This study was a randomized, double-blind, placebo-controlled trial of trazodone hydrochloride for the treatment of DPS. Following a 2-week placebo lead-in period, patients were randomized to a 6-week course of 150 mg trazodone hydrochloride/day or placebo. Evaluations of pain quality and intensity were performed at 2-week intervals, utilizing the McGill Pain Questionnaire, Sternbach Pain Intensity Scale, and Zung Pain and Distress Index. Neurologic examination and assessment of side effects were performed at each evaluation session. No significant changes were noted in reported pain measures between patients allocated to the active drug group and those given placebo during the course of the protocol. However, significantly more patients randomized to trazodone complained of side effects and prematurely terminated their participation in the study. The results of this investigation are consistent with those of other earlier trials which indicate that such antidepressant medications as trazodone hydrochloride which selectively inhibit presynaptic reuptake of serotonin, may not be effective in the control of certain pain syndromes. These results do not preclude the possible utility of these agents in the treatment of other pain syndromes or at higher doses than previously studied.

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About pain and its treatment in paraplegics

Cited by 20 publications

References 3 publications

Classification of pain following spinal cord injury

Classification of pain following spinal cord injury

International Spinal Cord Injury Pain Classification: part I. Background and description

Trazodone hydrochloride in the treatment of dysesthetic pain in traumatic myelopathy: a randomized, double-blind, placebo-controlled study

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