Pain Below the Level of Injury of the Spinal Cord

Pollock, Lewis J.; Brown, Meyer; Boshes, Benjamin; Finkelman, Isidore; Chor, Herman; Arieff, Alex J.; Finkle, John R.

doi:10.1001/archneurpsyc.1951.02320030056005

Cited by 44 publications

(20 citation statements)

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“…23,24 Further studies since then have confirmed this although there is also emerging evidence to suggest that neuropathic pain may arise from more 'downstream' changes in damaged nerve roots as well as 'upstream' changes in the brain.…”

Section: Mechanisms Of Neuropathic Pain Following Scimentioning

confidence: 94%

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

2008

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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.

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Section: Mechanisms Of Neuropathic Pain Following Scimentioning

confidence: 94%

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

2008

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“…These systems use a mix of pain location and site of origin, eg below lesion level, root and visceral, 3 site of trauma, radicular, below injury level 8 and segmental, radicular, phantom, visceral. 16 Some authors also use pain descriptors such as`dysaesthetic' 11,13,15 or`di use burning' and`early burning', 5 either alone or in combination with other criteria.…”

Section: Mixed Classi®cation Systemsmentioning

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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“…This is re¯ected in the classi®cations that were proposed in the past, which grouped di erent types of pain according to various criteria. One of the oldest classi®cations, which is nonetheless still current, is the division into three types of pain:`burning infralesional pain',`visceral pain', and`radicular pain', as published by Pollock et al, 1 Wright and Sweet 2 and also Melzack and Loeser. 3 Woolsey 4 and Donovan et al 5 adopted this classi®cation, but extended it bỳ psychogenic pain' and`pain in the neck and shoulder region'.…”

Section: Introductionmentioning

confidence: 99%

Chronic pain/dysaesthesiae in spinal cord injury patients: results of a multicentre study

Störmer

Gerner

Grüninger³

et al. 1997

Spinal Cord

225

158

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The aim of the multicentre study* entitled`Description and Documentation of Painful States in Spinal Cord Injury Patients', in addition to the description and documentation of chronic pain and stressful dysaesthesiae in SCI patients, was the search for correlations between these symptoms and medical and psychosocial variables. To this end, the sample was selected to be as representative as possible. All patients referred for in-patient or out-patient treatment at the centres taking part were enrolled in the study in order of presentation, providing they gave consent and met the inclusion criteria. Psychosocial, medical and demographic data were elicited by a standardized battery of questions and a standardized physical examination, as were any chronic pain/dysaesthesiae (P/D) present in any localization. Among 901 patients, 34% had no chronic pain or dysaesthesiae, 50% had pain only, 11% had painful dysaesthesiae and 5%, non-painful but chronic and distressing dysaesthesiae. The intensity of P/D was noted as seven or more on a 10 cm visual analogue scale by 61% of the patients a ected and was experienced as rather or very distressing in 75% of cases. Most (86%) P/D were located below the spinal lesion or in the transition zone. There were signi®cant correlations between the presence of P/D and age on questioning and at onset of the paraplegia/tetraplegia, problems with rectal paralysis, expectations of life as a paraplegic/tetraplegic, and subjective assessment of changes in working life. Highly signi®cant correlations were found with subjective distress resulting of paraplegia/tetraplegia as such, depressed mood and psychosomatic disturbances of wellbeing. Overall, among the selected variables of our study, we found that correlations between P/D and psychosocial variables were more frequent and closer than those between P/D and medical variables.

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Pain Below the Level of Injury of the Spinal Cord

Cited by 44 publications

References 0 publications

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

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

Classification of pain following spinal cord injury

Chronic pain/dysaesthesiae in spinal cord injury patients: results of a multicentre study

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