Assessment of neuropathic pain after spinal cord injury using quantitative pain drawings

Rösner, Jan; Lütolf, Robin; Hostettler, Pascal; Villiger, Michael; Clijsen, Ron; Hohenauer, Erich; Barbero, Marco; Curt, Armin; Hubli, Michéle

doi:10.1038/s41393-021-00616-6

Cited by 19 publications

(12 citation statements)

References 36 publications

(44 reference statements)

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“…Presence of allodynia was tested with 25°C and 40°C thermorollers (Somedic, Hörby, Sweden), a brush, and the International Spinal Cord Injury Pain Data Set (ISCPDS) questionnaire 35 . Based on previous literature, pain extent was reported as the number of 13 body regions being affected by NP 18,35 pain drawings using two DIN-A4 papers with standardized body charts (frontal/dorsal view) 37 . Shaded body areas of perceived NP at the moment were assessed by a) verbal descriptors, b) pain intensity (numeric rating scale, NRS; '0' = no pain, '10' = worst pain imaginable), and c) type of NP (evoked or spontaneous).…”

Section: Clinical Assessment and Pain Phenotypingmentioning

confidence: 99%

Identifying Discomplete Spinal Lesions: New Evidence from Pain-Autonomic Interaction in Spinal Cord Injury

Lütolf

Rösner

Curt

et al. 2021

Journal of Neurotrauma

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The clinical evaluation of spinal afferents is an important diagnostic and prognostic marker for neurological and functional recovery after spinal cord injury (SCI). Particularly important regarding neuropathic pain following SCI is the function of the spinothalamic tract (STT) conveying nociceptive and temperature information. Here, we investigated the added value of neurophysiological methods revealing discomplete STT lesions, i.e., residual axonal sparing in clinically complete STT lesions. Specifically, clinical pinprick testing and thermal thresholds were compared to objective contact heat-evoked potentials (CHEPs) and a novel measure of pain-autonomic interaction employing heat-induced sympathetic skin responses (SSR). The test stimuli (i.e., contact heat, pinprick) were applied below the lesion level in 32 subjects with thoracic SCI while corresponding heat-evoked responses (i.e., CHEPs and SSR) were recorded above the lesion (i.e., scalp and hand, respectively).Readouts of STT function were related to neuropathic pain characteristics. In subjects with abolished pinprick sensation, measures of thermosensation (10%), CHEPs (33%) and SSR (48%) revealed residual STT function. Importantly, SSRs can be used as an objective readout and when abolished, no other proxy indicated residual STT function. No relation was found between STT function readouts and spontaneous neuropathic pain intensity and extent. However, subjects with clinically preserved STT function presented more often with allodynia (54%) than subjects with discomplete (13%) or complete STT lesions (18%).In individuals with absent pinprick sensation, discomplete STT lesions can be revealed employing pain-autonomic measures. The improved sensitivity to discern STT lesion completeness might support revealing the interference with neuropathic pain following SCI.

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Section: Clinical Assessment and Pain Phenotypingmentioning

confidence: 99%

Identifying Discomplete Spinal Lesions: New Evidence from Pain-Autonomic Interaction in Spinal Cord Injury

Lütolf

Rösner

Curt

et al. 2021

Journal of Neurotrauma

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“…It was shown that these drawings are affected by pain and depression in patients with cervical degenerative disc disease [92] or cervical spine nerve involvement in chronic whiplash-associated disorders [93]. They are also a feasible and reliable tool to assess neuropathic pain following spinal cord injury [94]. Pain drawings are also predictive of functional outcome in patients undergoing surgical treatment for degenerative disc disease in the cervical spine [95].…”

Section: Discussionmentioning

confidence: 99%

Beyond the Knife—Reviewing the Interplay of Psychosocial Factors and Peripheral Nerve Lesions

Heinzel

Dadun

Prahm

et al. 2021

JPM

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Peripheral nerve injuries are a common clinical problem. They not only affect the physical capabilities of the injured person due to loss of motor or sensory function but also have a significant impact on psychosocial aspects of life. The aim of this work is to review the interplay of psychosocial factors and peripheral nerve lesions. By reviewing the published literature, we identified several factors to be heavily influenced by peripheral nerve lesions. In addition to psychological factors like pain, depression, catastrophizing and stress, social factors like employment status and worker’s compensation status could be identified to be influenced by peripheral nerve lesions as well as serving as predictors of functional outcome themselves, respectively. This work sheds a light not only on the impact of peripheral nerve lesions on psychosocial aspects of life, but also on the prognostic values of these factors of functional outcome. Interdisciplinary, individualized treatment of patients is required to identify patient at risk for adverse outcomes and provide them with emotional support when adapting to their new life situation.

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“…77 In most cases of SCI in humans, pain starts within a year after injury and can be experienced for many years thereafter. 115,133 Therefore, our compression model recapitulates aspects of pain experienced by patients with SCI.…”

Section: Discussionmentioning

confidence: 99%

Spinal cord injury in mice affects central and peripheral pathology in a severity-dependent manner

Bannerman

Douchant

Segal

et al. 2021

PAIN

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Chronic pain is a common medical complication experienced by those living with spinal cord injury (SCI) and leads to worsened quality of life. The pathophysiology of SCI pain is poorly understood, hampering the development of safe and efficacious therapeutics. We therefore sought to develop a clinically relevant model of SCI with a strong pain phenotype and characterize the central and peripheral pathology after injury. A contusion (50 kdyn) injury, with and without sustained compression (60 seconds) of the spinal cord, was performed on female C57BL/6J mice. Mice with compression of the spinal cord exhibited significantly greater heat and mechanical hypersensitivity starting at 7 days postinjury, concomitant with reduced locomotor function, compared with those without compression. Immunohistochemical analysis of spinal cord tissue revealed significantly less myelin sparing and increased macrophage activation in mice with compression compared with those without. As measured by flow cytometry, immune cell infiltration and activation were significantly greater in the spinal cord (phagocytic myeloid cells and microglia) and dorsal root ganglia (Ly6C 1 monocytes) after compression injury. We also decided to investigate the gastrointestinal microbiome, as it has been shown to be altered in patients with SCI and has recently been shown to play a role in immune system maturation and pain. We found increased dysbiosis of the gastrointestinal microbiome in an injury severity-dependent manner. The use of this contusioncompression model of SCI may help advance the preclinical assessment of acute and chronic SCI pain and lead to a better understanding of mechanisms contributing to this pain.

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Assessment of neuropathic pain after spinal cord injury using quantitative pain drawings

Cited by 19 publications

References 36 publications

Identifying Discomplete Spinal Lesions: New Evidence from Pain-Autonomic Interaction in Spinal Cord Injury

Identifying Discomplete Spinal Lesions: New Evidence from Pain-Autonomic Interaction in Spinal Cord Injury

Beyond the Knife—Reviewing the Interplay of Psychosocial Factors and Peripheral Nerve Lesions

Spinal cord injury in mice affects central and peripheral pathology in a severity-dependent manner

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