Management of neuropathic pain following spinal cord injury: now and in the future

Abstract

Objective: To provide an overview of our current understanding of the problem of neuropathic pain following spinal cord injury (SCI) and to suggest possible therapeutic options in the near future. Methods: Original research articles, reviews and book chapters on the subject of pain and SCI. Results: Neuropathic pain following SCI has presented a challenge not only for traditional concepts of how pain occurs but also for more recent conceptualizations. We have made substantial progress in identifying the common types of pain that occur following SCI, determining the prevalence and characteristics of pain, investigating some of the pathophysiological changes in the nervous system that may contribute to the presence of neuropathic SCI pain and examining the effectiveness of some treatments. However major challenges remain. We still need to reach consensus on an SCI pain taxonomy; our understanding of mechanisms and the relative contribution of changes in the periphery, spinal cord and brain is incompletely understood; there are few studies that indicate effective treatment options, particularly for neuropathic SCI pain; and treatment of the biological and psychological contributors to pain is often fragmented. Conclusion: Recent studies suggest the potential usefulness of new treatment approaches such as selective pharmacological agents, application of novel neurostimulation techniques and the use of cognitive approaches to modify the pain experience. Our increasing understanding of the problem combined with the promise of these new approaches offers hope for improved management of neuropathic pain following SCI in the near future.

Botulinum toxin type A for neuropathic pain in patients with spinal cord injury

“…In a recent study looking into placebo effects in peripheral nerve injury‐induced chronic neuropathic pain, there were placebo effects regarding hyperalgesia but none for spontaneous or evoked pain 50. Considering that the mechanisms of neuropathic pain in SCI differ from those caused by peripheral nerve injury, the placebo effects may also be different between SCI‐induced neuropathic pain and pain caused by injury to the peripheral nerve 53, 54. The subjects enrolled in this study had moderate to severe neuropathic pain, with VAS scores > 40 and durations > 3 months.…”

Anticonvulsant medication use for the management of pain following spinal cord injury: systematic review and effectiveness analysis

“…6,7 Evidence for the use of gabapentin and pregabalin is limited and based on small studies. 10,11 Given the limited evidence on anticonvulsant use for neuropathic pain after SCI 6,7,10 and patient surveys that document a lack of perceived effectiveness of these medications, 4 the purpose of this study was to perform a systematic review and if possible a metaanalysis of the effectiveness of anticonvulsants for the management of post-SCI neuropathic pain. Clarity regarding the effectiveness and potential risks of anticonvulsants for neuropathic pain after SCI is particularly important as neuropathic pain has a profound effect on the well-being of many individuals with SCI.…”

Future Directions in Neuropathic Pain Therapy: Closing the Translational Loop

“…Surveying online sources, including clinicaltrials.gov, as well as published reviews [5][6][7][8][9], we find a number of compounds targeting novel mechanisms of action in clinical trials (Table 1). These include the major glutamate neurotransmitter receptors-metabotropic, ␣-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid/kainate, and Nmethyl-D-aspartic acid-as well as cannabinoid receptors and transient receptor potential cation channel, subfamily V, member 1 (TRPV1) receptors.…”