Pain following spinal cord injury

Chronic pain is an important problem following spinal cord injury (SCI) and is a major impediment to effective rehabilitation. The reported prevalence of chronic SCI pain is variable but averages 65% with around one third of these people rating their pain as severe. The mechanisms responsible for the presence of pain are poorly understood. However, evidence from clinical observations and the use of animal models of SCI pain suggests that a number of processes may be important. These include functional and structural plastic changes in the central nervous system following injury, with changes in receptor function and loss of normal inhibition resulting in an increased neuronal excitability. A number of specific types of SCI pain can be distinguished based on descriptors, location and response to treatment. Nociceptive pain can arise from musculoskeletal structures and viscera and neuropathic pain can arise from spinal cord and nerve damage. The role of psychological and environmental factors also needs to be considered. Accurate identification of these pain types will help in selecting appropriate treatment approaches. Current treatments employ a variety of pharmacological, surgical, physical and psychological approaches. However, evidence for many of the treatments in use is still limited. It is hoped that future research will identify effective treatment strategies that accurately target specific mechanisms.Spinal Cord (2001) 39, 63–73.

[1]  A. Ward,et al.  Some effects of deafferentation on neurons of the cat spinal cord. , 1967, Archives of neurology.

[2]  Philippe Decq,et al.  Chronic motor cortex stimulation in the treatment of central and neuropathic pain. Correlations between clinical, electrophysiological and anatomical data , 1999, PAIN.

[3]  M. Backonja,et al.  Response of central pain syndromes to intravenous lidocaine. , 1992, Journal of pain and symptom management.

[4]  R. Kuhn,et al.  FUNCTITONAL CAPACITY OF THE ISOLATED HUMAN SPINAL CORD , 1950 .

[5]  M. Dimitrijevic,et al.  Neurophysiological approaches to chronic pain following spinal cord injury , 1982, Paraplegia.

[6]  L. E. White,et al.  Chronic deafferentation of human spinal cord neurons. , 1968, Journal of neurosurgery.

[7]  A. Drewes,et al.  Valproate for treatment of chronic central pain after spinal cord injury. A double-blind cross-over study , 1994, Paraplegia.

[8]  A. Friedman,et al.  DREZ lesions for relief of pain related to spinal cord injury. , 1986, Journal of neurosurgery.

[9]  F. Gerstenbrand,et al.  Phantom Illusions in Spinal Cord Lesions , 1981 .

[10]  C. Wienke,et al.  Chronic pain/dysaesthesiae in spinal cord injury patients: results of a multicentre study , 1997, Spinal Cord.

[11]  S. Tuel,et al.  Effect of mexiletine on spinal cord injury dysesthetic pain. , 1996, American journal of physical medicine & rehabilitation.

[12]  S. D'Luzansky,et al.  Intrathecal baclofen suppresses central pain in patients with spinal lesions. A pilot study. , 1992, The Clinical journal of pain.

[13]  R. Yezierski,et al.  Excitotoxic spinal cord injury: behavioral and morphological characteristics of a central pain model , 1998, Pain.

[14]  E. Roth,et al.  Function-limiting dysesthetic pain syndrome among traumatic spinal cord injury patients: a cross-sectional study , 1987, PAIN®.

[15]  T. Hökfelt,et al.  Chronic pain-related behaviors in spinally injured rats: Evidence for functional alterations of the endogenous cholecystokinin and opioid systems , 1994, Pain.

[16]  M. Fuhrer,et al.  Chronic pain in a community-based sample of men with spinal cord injury: prevalence, severity, and relationship with impairment, disability, handicap, and subjective well-being. , 1998, Archives of physical medicine and rehabilitation.

[17]  Sandford Pr,et al.  Amitriptyline and carbamazepine in the treatment of dysesthetic pain in spinal cord injury. , 1992 .

[18]  J. Frisbie,et al.  Chronic pain after spinal cord injury: an expedient diagnostic approach , 1990, Paraplegia.

[19]  S. Rutkowski,et al.  Pain report and the relationship of pain to physical factors in the first 6 months following spinal cord injury , 1999, Pain.

[20]  Ronald Melzack,et al.  Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence , 1993, Pain.

[21]  M. Levitt Dysesthesias and self-mutilation in humans and subhumans: A review of clinical and experimental studies , 1985, Brain Research Reviews.

[22]  D. McAdoo,et al.  Neurotoxicity of glutamate at the concentration released upon spinal cord injury , 1999, Neuroscience.

[23]  I. L. Johannesen,et al.  Lamotrigine in spinal cord injury pain: a randomized controlled trial , 2002, Pain.

[24]  R. Yezierski,et al.  Proton magnetic resonance spectroscopy of the thalamus in patients with chronic neuropathic pain after spinal cord injury. , 2002, AJNR. American journal of neuroradiology.

[25]  W. Donovan,et al.  Diagnostic spinal anaesthesia in chronic spinal cord injury pain , 1991, Paraplegia.

[26]  W. G. Kuhn The care and rehabilitation of patients with injuries of the spinal cord and cauda equina; a preliminary report on 113 cases. , 1947, Journal of neurosurgery.

[27]  A. Morel,et al.  Thalamus and neurogenic pain: physiological, anatomical and clinical data. , 1993, Neuroreport.

[28]  J. Stanghelle,et al.  Pain and life quality within 2 years of spinal cord injury , 1995, Paraplegia.

[29]  P. Siddall,et al.  Non-painful sensory phenomena after spinal cord injury , 1999, Journal of neurology, neurosurgery, and psychiatry.

[30]  Z. Wiesenfeld‐Hallin,et al.  Decreased GABA immunoreactivity in spinal cord dorsal horn neurons after transient spinal cord ischemia in the rat , 1994, Brain Research.

[31]  C. Blomstrand,et al.  Spinal Cord Injuries: Clinical, Functional, and Emotional Status , 1991 .

[32]  T. Ettlin,et al.  Phantom and amputation illusions in paraplegic patients. , 1980, European neurology.

[33]  A. Faden,et al.  Effect of Impact Trauma on Neurotransmitter and Nonneurotransmitter Amino Acids in Rat Spinal Cord , 1989, Journal of neurochemistry.

[34]  Z. Wiesenfeld‐Hallin,et al.  Transient spinal cord ischemia induces temporary hypersensitivity of dorsal horn wide dynamic range neurons to myelinated, but not unmyelinated, fiber input. , 1992, Journal of neurophysiology.

[35]  M. Nash,et al.  The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population , 1995, Paraplegia.

[36]  P. Siddall,et al.  Responses of spinal neurones to cutaneous and dorsal root stimuli in rats with mechanical allodynia after contusive spinal cord injury , 2001, Brain Research.

[37]  J. E. Robinson,et al.  Pain following spinal cord injury: result from a postal survey , 1988, Pain.

[38]  C. Glynn,et al.  Cerebrospinal fluid kinetics of epidural clonidine in man , 1992, Pain.

[39]  E. Roth,et al.  Trazodone hydrochloride in the treatment of dysesthetic pain in traumatic myelopathy: a randomized, double-blind, placebo-controlled study , 1987, Pain.

[40]  R. Tasker,et al.  Intractable pain of spinal cord origin: clinical features and implications for surgery. , 1992, Journal of neurosurgery.

[41]  S. Hill,et al.  Gabapentin for neuropathic pain following spinal cord injury , 2002, Spinal Cord.

[42]  M. Murray,et al.  Plasticity of dorsal root and descending serotoninergic projections after partial deafferentation of the adult rat spinal cord , 1990, The Journal of comparative neurology.

[43]  K. Keay,et al.  C-fos expression in the spinal cord of rats exhibiting allodynia following contusive spinal cord injury , 1999, Brain Research.

[44]  Ross Davis Pain and Suffering Following Spinal Cord Injury , 1975 .

[45]  R. Llinás,et al.  Thalamocortical dysrhythmia: A neurological and neuropsychiatric syndrome characterized by magnetoencephalography. , 1999, Proceedings of the National Academy of Sciences of the United States of America.

[46]  P. Eide Pathophysiological mechanisms of central neuropathic pain after spinal cord injury , 1998, Spinal Cord.

[47]  D. Munro THORACIC AND LUMBOSACRAL CORD INJURIES: A STUDY OF FORTY CASES , 1943 .

[48]  Deborah A Taylor,et al.  Classification of pain following spinal cord injury , 1997, Spinal Cord.

[49]  D. Bouhassira,et al.  Effects of IV morphine in central pain: A randomized placebo-controlled study , 2002, Neurology.

[50]  T. Milhorat,et al.  Dysesthetic pain in patients with syringomyelia. , 1996, Neurosurgery.

[51]  A. Brown Treatment of intractable pain by subarachnoid injection of carbolic acid. , 1958, Lancet.

[52]  P. Sved,et al.  Relationship between surgery and pain following spinal cord injury , 1997, Spinal Cord.

[53]  R M Levy,et al.  Treatment of chronic pain by deep brain stimulation: long term follow-up and review of the literature. , 1988, Neurosurgery.

[54]  C. Vierck,et al.  Effects of combined hemotoxic and anterolateral spinal lesions on nociceptive sensitivity , 1999, PAIN®.

[55]  D. Thomas,et al.  Pain and the neurosurgeon. , 1994, Acta neurochirurgica.

[56]  M. Beattie,et al.  An Analysis of Changes in Sensory Thresholds to Mild Tactile and Cold Stimuli after Experimental Spinal Cord Injury in the Rat , 2000, Neurorehabilitation and neural repair.

[57]  P. Kennedy,et al.  Factors associated with acute and chronic pain following traumatic spinal cord injuries , 1997, Spinal Cord.

[58]  S. L. Stover,et al.  Effect of bullet removal on subsequent pain in persons with spinal cord injury secondary to gunshot wound. , 1990, Journal of neurosurgery.

[59]  M. Childers,et al.  The Use of Gabapentin for Neuropathic and Musculoskeletal Pain: A Case Series , 1998 .

[60]  R. Yezierski,et al.  Chronic pain after spinal injury: interference with sleep and daily activities. , 2001, Archives of physical medicine and rehabilitation.

[61]  R. Umlauf Psychological Interventions for Chronic Pain Following Spinal Cord Injury , 1992, The Clinical journal of pain.

[62]  R. Kuhn,et al.  Functional capacity of the isolated human spinal cord. , 1950, Brain : a journal of neurology.

[63]  A. Obert,et al.  Computer-assisted DREZ microcoagulation: posttraumatic spinal deafferentation pain. , 1993, Journal of spinal disorders.

[64]  C. Hulsebosch,et al.  Mechanical and thermal allodynia in chronic central pain following spinal cord injury , 1996, Pain.

[65]  A. Mariano,et al.  Chronic pain and spinal cord injury. , 1992, The Clinical journal of pain.

[66]  Xiao-jun Xu,et al.  Effects of intrathecal vs. systemic clonidine in treating chronic allodynia-like response in spinally injured rats , 1996, Brain Research.

[67]  C. Hulsebosch,et al.  Chronic central pain after spinal cord injury. , 1997, Journal of neurotrauma.

[68]  T. Jensen,et al.  Pharmacological treatment of spinal cord injury pain , 2002 .

[69]  P. Potter A survey of pain during rehabilitation after acute spinal cord injury Spinal Cord; Vol 35 No 10, October 1997; 658–663 , 1998, Spinal Cord.

[70]  R. Yezierski,et al.  Neuronal degeneration and spinal cavitation following intraspinal injections of quisqualic acid in the rat. , 1993, Journal of neurotrauma.

[71]  K Hancock,et al.  Long-term psychological outcomes in spinal cord injured persons: results of a controlled trial using cognitive behavior therapy. , 1997, Archives of physical medicine and rehabilitation.

[72]  S. L. Stover,et al.  Pain in patients with spinal cord injury. , 1979, Archives of physical medicine and rehabilitation.

[73]  C. Hulsebosch,et al.  Spinal Cord Injury and Anti-NGF Treatment Results in Changes in CGRP Density and Distribution in the Dorsal Horn in the Rat , 1997, Experimental Neurology.

[74]  H. Waisbrod,et al.  Chronic pain in paraplegics. , 1984, Neurosurgery.

[75]  Z. Wiesenfeld‐Hallin,et al.  Chronic pain-related syndrome in rats after ischemic spinal cord lesion: a possible animal model for pain in patients with spinal cord injury , 1992, Pain.

[76]  Jonathan O. Dostrovsky,et al.  Characteristics of the bursting pattern of action potentials that occurs in the thalamus of patients with central pain , 1989, Brain Research.

[77]  M. Dimitrijevic,et al.  Central dysesthesia syndrome in spinal cord injury patients , 1988, Pain.

[78]  D. Bouhassira,et al.  Intravenous lidocaine in central pain , 2000, Neurology.

[79]  C. Warms,et al.  Efficacy of amitriptyline for relief of pain in spinal cord injury: results of a randomized controlled trial , 2002, Pain.

[80]  R. A. Davidoff,et al.  CHANGES IN AMINO ACID CONCENTRATIONS ASSOCIATED WITH LOSS OF SPINAL INTERNEURONS * , 1967, Journal of neurochemistry.

[81]  H. Rusk,et al.  Pain and spasticity in patients with spinal cord dysfunction. Results of a follow-up study. , 1962, JAMA.

[82]  R. Lentini,et al.  Transcutaneous nerve stimulation for treatment of pain in patients with spinal cord injury. , 1975, Surgical neurology.

[83]  A. Kohli,et al.  Chronic pain in spinal cord injury: comparison between inpatients and outpatients. , 1985, Archives of physical medicine and rehabilitation.

[84]  R. Lende,et al.  Central pain of spinal cord origin , 1965, Neurology.

[85]  G. Riddoch THE REFLEX FUNCTIONS OF THE COMPLETELY DIVIDED SPINAL CORD IN MAN, COMPARED WITH THOSE ASSOCIATED WITH LESS SEVERE LESIONS , 1917 .

[86]  Krishna Kumar,et al.  Deep brain stimulation for intractable pain: a 15-year experience. , 1997, Neurosurgery.

[87]  A. Heilporn Two therapeutic experiments on stubborn pain in spinal cord lesions: coupling melitracen-flupenthixol and the transcutaneous nerve stimulation , 1978, Paraplegia.

[88]  K. D. Davis,et al.  A comparison of the burst activity of lateral thalamic neurons in chronic pain and non-pain patients , 1999, Pain.

[89]  Y. Hosobuchi Subcortical electrical stimulation for control of intractable pain in humans. Report of 122 cases (1970-1984). , 1986, Journal of neurosurgery.

[90]  Z. Wiesenfeld‐Hallin,et al.  Baclofen reverses the hypersensitivity of dorsal horn wide dynamic range neurons to mechanical stimulation after transient spinal cord ischemia; implications for a tonic GABAergic inhibitory control of myelinated fiber input. , 1992, Journal of neurophysiology.

[91]  K Hancock,et al.  Improving the long-term adjustment of spinal cord injured persons , 1999, Spinal Cord.

[92]  R. Yezierski,et al.  The mechanosensitivity of spinal sensory neurons following intraspinal injections of quisqualic acid in the rat , 1993, Neuroscience Letters.

[93]  K. Takakura,et al.  A new approach to the control of central deafferentation pain--spinal intrathecal baclofen. , 1995, Acta neurochirurgica. Supplement.

[94]  B. Komisaruk,et al.  'Complete' spinal cord injury does not block perceptual responses to genital self-stimulation in women. , 1997, Archives of neurology.

[95]  D. Bowsher Central pain of spinal origin , 1996, Spinal Cord.

[96]  P. Mertens,et al.  Microsurgical DREZotomy for pain due to spinal cord and/or cauda equina injuries: long-term results in a series of 44 patients , 2001, Pain.

[97]  J. Wrathall,et al.  Increase in nerve growth factor-like immunoreactivity and decrease in choline acetyltransferase following contusive spinal cord injury , 1991, Brain Research.

[98]  Santosh Lal,et al.  Premature degenerative shoulder changes in spinal cord injury patients , 1998, Spinal Cord.

[99]  L. White,et al.  Denervation hyperpathia: a convulsive syndrome of the spinal cord responsive to carbamazepine therapy. , 1971, Journal of neurosurgery.

[100]  Yoichi Katayama,et al.  Thalamic neuronal hyperactivity following transection of the spinothalamic tract in the cat: involvement ofN-methyl-d-aspartate receptor , 1993, Brain Research.

[101]  D. Cardenas,et al.  Upper extremity pain after spinal cord injury , 1999, Spinal Cord.

[102]  B. Nashold,et al.  Pain and spinal cysts in paraplegia: treatment by drainage and DREZ operation. , 1990, British journal of neurosurgery.

[103]  R. Yezierski,et al.  Effects of adrenal medullary transplants on pain-related behaviors following excitotoxic spinal cord injury , 1998, Brain Research.

[104]  N. Kesiktaş,et al.  Pain following spinal cord injury , 1998, Spinal Cord.

[105]  R. Moore,et al.  ROLE OF SPINAL NORADRENERGIC SYSTEM IN TRANSMISSION OF PAIN IN PATIENTS WITH SPINAL CORD INJURY , 1986, The Lancet.

[106]  P. Eide,et al.  Central dysesthesia pain after traumatic spinal cord injury is dependent on N-methyl-D-aspartate receptor activation. , 1995, Neurosurgery.

[107]  M. Dimitrijevic,et al.  A clinical syndrome of rostral and caudal spinal injury: neurological, neurophysiological and urodynamic evidence for occult sacral lesion. , 1987, Journal of neurology, neurosurgery, and psychiatry.

[108]  B. Nashold,et al.  Dorsal column stimulation for control of pain. Preliminary report on 30 patients. , 1972, Journal of neurosurgery.

[109]  George Varghese,et al.  Psychosocial factors in chronic spinal cord injury pain , 1991, Pain.

[110]  小山 哲男 Nociceptive neurons in the macaque anterior cingulate activate during anticipation of pain , 2000 .

[111]  E. Bullitt,et al.  Dorsal root entry zone lesions to control central pain in paraplegics. , 1981, Journal of neurosurgery.

[112]  P. Sandford,et al.  Amitriptyline and carbamazepine in the treatment of dysesthetic pain in spinal cord injury. , 1992, Archives of physical medicine and rehabilitation.

[113]  P. Reier,et al.  Altered patterns of reflex excitability subsequent to contusion injury of the rat spinal cord. , 1992, Journal of neurophysiology.

[114]  M. Maury About pain and its treatment in paraplegics , 1978, Paraplegia.

[115]  N. Westgren,et al.  Quality of life and traumatic spinal cord injury. , 1998, Archives of physical medicine and rehabilitation.

[116]  L. Davis,et al.  Studies upon Spinal Cord Injuries , 1947 .

[117]  William H. Calvin,et al.  Mechanosensitivity of dorsal root ganglia and chronically injured axons: A physiological basis for the radicular pain of nerve root compression , 1977, Pain.

[118]  G. Holmes Pain of Central Origin , 1922 .

[119]  C. Hubscher,et al.  Changes in neuronal receptive field characteristics in caudal brain stem following chronic spinal cord injury. , 1999, Journal of neurotrauma.

[120]  Ronald Melzack,et al.  Phantom body pain in paraplegics: Evidence for a central “pattern generating mechanism” for pain , 1977, Pain.

[121]  A. Berić POST-SPINAL CORD INJURY PAIN STATES , 1997 .

[122]  J. Levitt,et al.  The deafferentation syndrome in monkeys: Dysesthesias of spinal origin , 1981, Pain.

[123]  C. Hulsebosch,et al.  Rodent model of chronic central pain after spinal cord contusion injury and effects of gabapentin. , 2000, Journal of neurotrauma.

[124]  M. Giner,et al.  Chronic pain in the spinal cord injured: statistical approach and pharmacological treatment , 1993, Paraplegia.

[125]  D. Brown,et al.  A survey of pain during rehabilitation after acute spinal cord injury , 1997, Spinal Cord.

[126]  J. Mountz,et al.  A case of spinal cord injury-related pain with baseline rCBF brain SPECT imaging and beneficial response to gabapentin , 1998, Pain.

[127]  C. O’Brien,et al.  Treatment of Spasticity With Botulinum Toxin , 2002, The Clinical journal of pain.

[128]  L. Davis Treatment of spinal cord injuries. , 1954, A.M.A. archives of surgery.

[129]  R. Heimburger,et al.  Surgical relief of pain in paraplegic patients. , 1947, Transactions. Western Surgical Association.

[130]  R. Young,et al.  Clinical experience with radiofrequency and laser DREZ lesions. , 1990, Journal of neurosurgery.

[131]  M. Meglio,et al.  Spinal cord stimulation in the treatment of paraplegic pain. , 1995, Journal of neurosurgery.

[132]  J. Broton,et al.  Perceived difficulty in dealing with consequences of spinal cord injury. , 1999, Archives of physical medicine and rehabilitation.

[133]  G. Bennett,et al.  Psycho-social aspects of chronic pain in spinal cord injury , 1980, PAIN.

[134]  P. Siddall,et al.  Allodynia following traumatic spinal cord injury in the rat. , 1995, Neuroreport.

[135]  S. Canavero,et al.  Cordomyelotomy in the treatment of paraplegia pain. Experience in two cases with long-term results. , 1995, Acta Neurologica Belgica.

[136]  D. Burke Pain in paraplegia , 1973, Paraplegia.

[137]  R. Yezierski Pain following spinal cord injury: the clinical problem and experimental studies , 1996, Pain.

[138]  S. Rutkowski,et al.  The Efficacy of Intrathecal Morphine and Clonidine in the Treatment of Pain After Spinal Cord Injury , 2000, Anesthesia and analgesia.

[139]  Z. Wiesenfeld‐Hallin,et al.  Allodynia-like effects in rat after ischaemic spinal cord injury photochemically induced by laser irradiation , 1991, Pain.

[140]  N. Blumen,et al.  Characterization of chronic pain and somatosensory function in spinal cord injury subjects , 2001, Pain.

[141]  B. Sjölund,et al.  Long term results of peripheral conditioning stimulation as an analgesic measure in chronic pain , 1979, PAIN.

[142]  C. Vierck,et al.  Functional plasticity in primate somatosensory thalamus following chronic lesion of the ventral lateral spinal cord , 2000, Neuroscience.

[143]  Xiao-jun Xu,et al.  Treatment of chronic allodynia in spinally injured rats: effects of intrathecal selective opioid receptor agonists , 1998, Pain.

[144]  R. Richardson,et al.  Neurostimulation in the modulation of intractable paraplegic and traumatic neuroma pains , 1980, PAIN.

[145]  J. Nunemacher,et al.  Optimal management of giant cell arteritis and polymyalgia rheumatica , 2012, Therapeutics and clinical risk management.

[146]  P. Loubser,et al.  Effects of intrathecal baclofen on chronic spinal cord injury pain. , 1996, Journal of pain and symptom management.

[147]  F. Adler A Case , 1863, The Lancet.