Central Neuropathic Pain after Acute Spinal Cord Injury (NP in SCI): A Case series of 494 SCI cases
Abstract
Pain following Spinal Cord Injury (SCI) is very common. So this study was conducted to find out prevalence, associated factors and pattern of Neuropathic Pain (NP) among SCI patients, for which 494 consecutive eligible patients of Spinal Cord Injury (SCI) admitted in the Department were evaluated for NP. It was observed that 13.76% of SCI patients complained of neuropathic pain. In 21 to 30 years age group 23.13% and 61.76% cases of neuropathic pain had dorso-lumbar injury. 48.30% cases of neuropathic pain had onset in 2nd and 3rd week. Discomfort was more at night (36.76%), in below the knee area and dorsum of the foot. Hot burning type of sensation was the commonest descriptor of NP and range of movement (ROM) exercises and tepid cold water sponging were relieving factors.
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Introduction
Pain following Spinal Cord Injury (SCI) is a syndrome which includes all the pain types occurring in a spinal cord injury patient. In 1917 Riddoch1 first addressed the problem in war sufferers and later on it was investigated over the period of time with variable results.
The pathophysiology of neuropathic pain is an area of intense interest and controversy. Initial interest was focused on the role of peripheral nerve injury. It is now clear that the central mechanisms are of importance as well. Peripheral sensitization is caused by the lowering of the threshold to fire, Primary hyperalgesia, Differentiation results from the destruction of nerve fibres & Central sensitization is the result of hyper excitability of spinal-cord neurons in response to repeated peripheral stimulation.1,2 It is well known that any type of pain perception is altered with emotional and psychological factors, Neuropathic pain after SCI is not an exception here pain intensity and perception can be altered with feeling of helplessness, loneliness, anxiety and depression which are invariably associated with SCI.
Prevalence of post SCI pain is ranging between 18 – 94%2-8 , with one third of the cases rating their pain as severe2 . Post SCI pain classified as visceral, musculoskeletal and Neuropathic Pain etc9 , and neuropathic pain is the most common pain type during inpatient rehabilitation6 and major component of the total pain experience.10 Rintala et al5 estimated 75% of chronic SCI pain and 10.1% of central pain prevalence among community based sample in spinal cord injured males.
Conclusion
Neuropathic pain is found in 13.76% of SCI patients and age is significantly associated factor. It is most frequently described as hot burning type of sensation and is commonly present in dorso-lumber SCI with high incidence in 21-30 year age group. Below knee area and dorsum of foot are commonest areas of discomfort and nights are more distressing it is relieved by physical modalities in most of the patients.