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Management of Neuropathic Pain Associated with Spinal Cord Injury

Spinal cord injury (SCI) is an injury to the spinal cord that leads to varying degrees of motor and/or sensory deficits and paralysis. Chronic pain of both neuropathic and nociceptive type is common and contributes to reduced quality of life. The aim of the review is to provide current clinical unde...

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Autores principales: Hagen, Ellen M., Rekand, Tiina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470971/
https://www.ncbi.nlm.nih.gov/pubmed/25744501
http://dx.doi.org/10.1007/s40122-015-0033-y
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author Hagen, Ellen M.
Rekand, Tiina
author_facet Hagen, Ellen M.
Rekand, Tiina
author_sort Hagen, Ellen M.
collection PubMed
description Spinal cord injury (SCI) is an injury to the spinal cord that leads to varying degrees of motor and/or sensory deficits and paralysis. Chronic pain of both neuropathic and nociceptive type is common and contributes to reduced quality of life. The aim of the review is to provide current clinical understanding as well as discuss and evaluate efficacy of pharmacological interventions demonstrated in the clinical studies. The review was based on literature search in PubMed and Medline with words “neuropathic pain” and “spinal cord injury”. The review included clinical studies and not experimental data nor case reports. A limited number of randomized and placebo-controlled studies concerning treatment options of neuropathic pain after SCI were identified. Amitriptyline, a tricyclic antidepressant and the antiepileptic drugs, gabapentin and pregabalin, are most studied with demonstrated efficacy, and considered to be the primary choice. Opioids have demonstrated conflicting results in the clinical studies. In addition, administration route used in the studies as well as reported side effects restrict everyday use of opioids as well as ketamine and lidocaine. Topical applications of capsaicin or lidocaine as well as intradermal injections of Botulinum toxin are new treatment modalities that are so far not studied on SCI population and need further studies. Non-pharmacological approaches may have additional effect on neuropathic pain. Management of pain should always be preceded by thorough clinical assessment of the type of pain. Patients need a follow-up to evaluate individual effect of applied measures. However, the applied management does not necessarily achieve satisfactory pain reduction. Further clinical studies are needed to evaluate the effect of both established and novel management options.
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spelling pubmed-44709712015-06-18 Management of Neuropathic Pain Associated with Spinal Cord Injury Hagen, Ellen M. Rekand, Tiina Pain Ther Review Spinal cord injury (SCI) is an injury to the spinal cord that leads to varying degrees of motor and/or sensory deficits and paralysis. Chronic pain of both neuropathic and nociceptive type is common and contributes to reduced quality of life. The aim of the review is to provide current clinical understanding as well as discuss and evaluate efficacy of pharmacological interventions demonstrated in the clinical studies. The review was based on literature search in PubMed and Medline with words “neuropathic pain” and “spinal cord injury”. The review included clinical studies and not experimental data nor case reports. A limited number of randomized and placebo-controlled studies concerning treatment options of neuropathic pain after SCI were identified. Amitriptyline, a tricyclic antidepressant and the antiepileptic drugs, gabapentin and pregabalin, are most studied with demonstrated efficacy, and considered to be the primary choice. Opioids have demonstrated conflicting results in the clinical studies. In addition, administration route used in the studies as well as reported side effects restrict everyday use of opioids as well as ketamine and lidocaine. Topical applications of capsaicin or lidocaine as well as intradermal injections of Botulinum toxin are new treatment modalities that are so far not studied on SCI population and need further studies. Non-pharmacological approaches may have additional effect on neuropathic pain. Management of pain should always be preceded by thorough clinical assessment of the type of pain. Patients need a follow-up to evaluate individual effect of applied measures. However, the applied management does not necessarily achieve satisfactory pain reduction. Further clinical studies are needed to evaluate the effect of both established and novel management options. Springer Healthcare 2015-03-06 2015-06 /pmc/articles/PMC4470971/ /pubmed/25744501 http://dx.doi.org/10.1007/s40122-015-0033-y Text en © The Author(s) 2015 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Review
Hagen, Ellen M.
Rekand, Tiina
Management of Neuropathic Pain Associated with Spinal Cord Injury
title Management of Neuropathic Pain Associated with Spinal Cord Injury
title_full Management of Neuropathic Pain Associated with Spinal Cord Injury
title_fullStr Management of Neuropathic Pain Associated with Spinal Cord Injury
title_full_unstemmed Management of Neuropathic Pain Associated with Spinal Cord Injury
title_short Management of Neuropathic Pain Associated with Spinal Cord Injury
title_sort management of neuropathic pain associated with spinal cord injury
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470971/
https://www.ncbi.nlm.nih.gov/pubmed/25744501
http://dx.doi.org/10.1007/s40122-015-0033-y
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