Treatments for Chronic Pain Associated With Spinal Cord Injuries: Many Are Tried, Few Are Helpful

Warms, Catherine A.; Turner, Judith A.; Marshall, Helen M.; Cardenas, Diana D.

doi:10.1097/00002508-200205000-00004

Cited by 159 publications

(122 citation statements)

References 39 publications

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“…These results are alarming given the widespread use of morphine for the clinical treatment of pain after a spinal cord injury [61,62]. If one injection of morphine can affect recovery, the potential consequences of long-term treatment could be substantial.…”

Section: Discussionmentioning

confidence: 99%

The impact of morphine after a spinal cord injury

Hook

Liu

Washburn

et al. 2007

Behavioural Brain Research

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Nociceptive stimulation, at an intensity that elicits pain-related behavior, attenuates recovery of locomotor and bladder functions, and increases tissue loss after a contusion injury. These data imply that nociceptive input (e.g., from tissue damage) can enhance the loss of function after injury, and that potential clinical treatments, such pretreatment with an analgesic, may protect the damaged system from further secondary injury. The current study examined this hypothesis and showed that a potential treatment (morphine) did not have a protective effect. In fact, morphine appeared to exacerbate the effects of nociceptive stimulation. Experiment 1 showed that after spinal cord injury 20 mg/kg of systemic morphine was necessary to induce strong antinociception and block behavioral reactivity to shock treatment, a dose that was much higher than that needed for sham controls. In Experiment 2, contused rats were given one of three doses of morphine (Vehicle, 10, 20 mg/kg) prior to exposure to uncontrollable electrical stimulation or restraint alone. Despite decreasing nociceptive reactivity, morphine did not attenuate the long-term consequences of shock. Rats treated with morphine and shock had higher mortality rates, and displayed allodynic responses to innocuous sensory stimuli three weeks later. Independent of shock, morphine per se undermined recovery of sensory function. Rats treated with morphine alone also had significantly larger lesions than those treated with saline. These results suggest that nociceptive stimulation affects recovery despite a blockade of pain-elicited behavior. The results are clinically important because they suggest that opiate treatment may adversely affect the recovery of function after injury.

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Section: Discussionmentioning

confidence: 99%

The impact of morphine after a spinal cord injury

Hook

Liu

Washburn

et al. 2007

Behavioural Brain Research

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“…This measure was used in a previous study of SCI. 28 Pain treatments A total of 17 treatments identified during interviews and in previous studies 9,28 (ie, heat therapy, ice therapy, massage therapy, ultrasound, transcutaneous electrical nerve stimulation (TENS), acupuncture, other physical therapy, occupational therapy, nerve blocks, surgery, trigger point injections, chiropractic manipulation, psychotherapy, hypnosis, meditation, and herbal medicine) were listed in the questionnaire. They could also add additional treatments to the list.…”

Section: Participantsmentioning

confidence: 99%

“…Treatment, however, is often inadequate. 9 One explanation for the failure of reasonable pain control is that the mechanisms causing and sustaining pain are not well understood. [10][11][12] People with SCI may experience one or more types of pain simultaneously.…”

Section: Introductionmentioning

confidence: 99%

Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics

2003

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Study design: Postal survey. Objectives: Because of the high prevalence and inadequate control of pain following spinal cord injury (SCI), it is important to have information about the factors associated with the use of specific pain therapies. We conducted this study to evaluate the ability of pain characteristics and psychosocial factors to predict the use of treatments. Setting: The Miami Project to Cure Paralysis (Miami, FL, USA). Methods: People with SCI (n ¼ 120) were mailed a packet containing a questionnaire with questions regarding demographic factors, pain characteristics, and pain treatments along with a copy of the Multidimensional Pain Inventory. Results: A total of 59% of the respondents had been prescribed treatment or self-initiated efforts to treat pain over the previous 18-month period. The most common treatments used by this sample were massage (26.6%), opioids (22.5%) and nonsteroidal anti-inflammatory drugs (NSAIDs) (20%). The most effective treatments overall were 'physical therapies' with 50% receiving these treatments indicating that their pain was 'considerably reduced' or that they were 'pain free.' Opioids and anticonvulsants were perceived to be the most effective pharmacological agents prescribed (33.3 and 23.8% reporting their pain was considerably better or eliminated, respectively). People using prescription medication reported significantly greater pain severity, more widespread pain, more descriptive adjectives, more evoked pain, greater difficulty in dealing with pain, and more interference and decreased activity levels due to pain, compared to people not using prescription medication. A combination of greater difficulty in dealing with pain, intense pain, presence of evoked pain, and higher level of perceived support from significant others was predictive of taking prescription medication. Conclusion: People taking prescription medication reported significantly more intense pain with neuropathic characteristics that significantly affected daily life and routine activities. A substantial percentage of individuals with pain related to SCI did not obtain significant pain relief from prescription medications. None of the factors assessed predicted the use of nonprescription treatments. The results of this study confirm the inadequacy of available modalities to manage chronic pain related to SCI.

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“…The presence of chronic pain has been reported to decrease quality of life after SCI [2,[10][11][12] and to frequently interfere with both sleep and common daily activities [2,[5][6]8,13]. Chronic pain in individuals with SCI is particularly problematic because several types of pain may exist simultaneously [2,[6][7][8][9][14][15], and many of these pains are refractory to currently available treatments [8,[16][17][18][19][20][21]. Because pain in this patient population is heterogeneous and persons with SCI often present with more than one type of pain, each pain should be evaluated separately to the extent possible.…”

Section: Introductionmentioning

confidence: 99%

Chronic pain after spinal cord injury: What characteristics make some pains more disturbing than others?

Felix¹,

Cruz-Almeida

Widerström-Noga

2007

JRRD

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Abstract-Different types of pain are often present in the same individual with spinal cord injury (SCI). Relieving the most disturbing of these pains may substantially affect quality of life. Persons with SCI and chronic pain (n = 194) completed a structured interview that detailed the characteristics of each pain they experienced. Pairwise analyses revealed that the following characteristics were more common among the most disturbing pains: "sharp"; "stabbing"; located at the level of injury; frequently aggravated; and having high intensity, unpleasantness, constancy, interference, and neuropathic painlike features. A conditional logistic regression analysis showed that the combination of "sharp" and high pain intensity, interference, aggravation, and constancy significantly predicted the most disturbing pain (p < 0.001). This study suggests that, in addition to pain intensity, factors such as interference, quality, aggravation, and constancy of pain are important to consider when one evaluates SCI-related pain, since these symptoms may indicate pains that are particularly disturbing to an individual with SCI.

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Treatments for Chronic Pain Associated With Spinal Cord Injuries: Many Are Tried, Few Are Helpful

Cited by 159 publications

References 39 publications

The impact of morphine after a spinal cord injury

The impact of morphine after a spinal cord injury

Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics

Chronic pain after spinal cord injury: What characteristics make some pains more disturbing than others?

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