Emerging Evidence for Intrathecal Management of Neuropathic Pain Following Spinal Cord Injury

Abstract

A high prevalence of patients with spinal cord injury (SCI) suffer from chronic neuropathic pain. Unfortunately, the precise pathophysiological mechanisms underlying this phenomenon have yet to be clearly elucidated and targeted treatments are largely lacking. As an unfortunate consequence, neuropathic pain in the population with SCI is refractory to standard of care treatments and represents a significant contributor to morbidity and suffering. In recent years, advances from SCI-specific animal studies and translational models have furthered our understanding of the neuronal excitability, glial dysregulation, and chronic inflammation processes that facilitate neuropathic pain. These developments have served advantageously to facilitate exploration into the use of neuromodulation as a treatment modality. The use of intrathecal drug delivery (IDD), with novel pharmacotherapies, to treat chronic neuropathic pain has gained particular attention in both pre-clinical and clinical contexts. In this evidence-based narrative review, we provide a comprehensive exploration into the emerging evidence for the pathogenesis of neuropathic pain following SCI, the evidence basis for IDD as a therapeutic strategy, and novel pharmacologics across impactful animal and clinical studies.

Resveratrol suppresses neuroinflammation to alleviate mechanical allodynia by inhibiting Janus kinase 2/signal transducer and activator of transcription 3 signaling pathway in a rat model of spinal cord injury

“…Oral Res has the characteristics of rapid absorption but low bioavailability ( Walle et al, 2004 ). Intrathecal drug delivery has been considered as a highly favorable pharmacologic delivery system given that spinal cord dorsal contains a majority of therapeutic drug target ( Karri et al, 2022 ). Previous research reported that intrathecal administration with Res had higher bioavailability and blood brain penetrability to treat rat intracranial glioblastomas compared to systematic administration ( Shu et al, 2015 ).…”

Concise review: Current understanding of extracellular vesicles to treat neuropathic pain

“…Neuroinflammatory activation of glial cells and immune cells after nerve injury is being increasingly implicated in neuropathic pain (Chambel et al, 2020;Karri et al, 2022). EVs pose tremendous antiinflammatory capacity following nerve injury and the roles of EVs in neuropathic pain will be a particularly interesting area of future inquiry.…”