Dysesthetic Pain in Patients with Syringomyelia

Milhorat, Thomas H.; Kotzen, René M.; Mu, Harrison T.M.; Capocelli, Anthony L.; Milhorat, Robert H.

doi:10.1097/00006123-199605000-00017

Cited by 96 publications

(39 citation statements)

References 46 publications

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“…Below-level pain after SCI may, for example, involve damage to the dorsal columns, because pain as-sociated with syringomyelia is reported to be more prevalent when a central cavity expands to include dorsal pathways [74] . Similarly, animal models of dysesthesia/ pain have shown that interruption of the dorsal or dorsolateral columns increases the incidence of overgrooming/ autotomy after peripheral nerve injury, and allodynia/hyperalgesia is observed in response to stimulation caudal and ipsilateral to dorsolateral column lesions in monkeys.…”

Section: Animal Models Of Below-level Painmentioning

confidence: 99%

Spinal Cord Injury: A Model of Central Neuropathic Pain

Yezierski

2005

Neurosignals

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The condition of pain after spinal cord injury (SCI) affects the life quality of nearly 70% of individuals with SCI. Clinical studies over the past decade have provided important insights into the complexities of the clinical and psychosocial characteristics of this debilitating consequence of SCI. The use of experimental models developed to study at-level or below-level pain has provided an appreciation for the mechanism(s) responsible for the onset and progression of these conditions. Important to the studies related to SCI pain has been the focus on the molecular, biochemical, anatomical, and functional consequences of SCI that have identified potential therapeutic targets for the design of novel treatment strategies.

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Section: Animal Models Of Below-level Painmentioning

confidence: 99%

Spinal Cord Injury: A Model of Central Neuropathic Pain

Yezierski

2005

Neurosignals

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“…69 This pain always has a delayed onset, perhaps even may be years after the SCI. The development of a syrinx is characterized by new neurological de®cits at a higher level than the original injury.…”

Section: Syringomyeliamentioning

confidence: 99%

Pain following spinal cord injury

2001

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Chronic pain is an important problem following spinal cord injury (SCI) and is a major impediment to eective 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 speci®c 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 identi®cation 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 eective treatment strategies that accurately target speci®c mechanisms. Spinal Cord (2001) 39, 63 ± 73Keywords: spinal cord injuries; pain; neuropathic pain; paraplegia; tetraplegia Historical overviewChronic pain is a major problem in those who have sustained a spinal cord or cauda equina injury.1 These patients usually have devastating neurological de®cits. A signi®cant proportion also suers from chronic pain. Riddoch 2 addressed the problem of pain after SCI in his 1917 paper although Munro's classic paper on spinal cord injuries in 1943 did not even mention the issue of chronic pain.3 After WW II, Botterell et al. 4described chronic pain in 12/103 SCI patients and 11 of these 12 had cauda equina injuries. Kuhn 5 reported that 0.234% of the injuries in WW II involved the spinal cord and that 22.5% of 113 patients with SCI had chronic pain. Prevalence/incidenceSince then, there have been numerous reports regarding the incidence and prevalence of pain following SCI. In 1962, Kaplan 6 attempted to classify SCI pains and stated that 37% of 52 SCI patients had chronic pain 1 year after injury and this increased to 50% by 5 years after injury. Davis 7 reported an incidence of 27% in 471 SCI patients. Richards et al.8 claimed that 77% of 88 SCI patients had chronic pain and that psychosocial variables predicted about 1/2 of the variance. Woolsey 9 identi®ed less than a 20% incidence of chronic pain in a group of 100 SCI patients.A number of more recent studies have all contributed data on the incidence and prevalence of pain after SCI.10 ± 17 The methodology and the patient population being studied appear to greatly in¯uence the reported incidence of SCI pain but across studies it appears...

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“…The persistence of dysesthetic pain (especially in group B) was characteristic for patients with collapse of their syrinxes [35]. Patients of both groups had similar bony and CSF space abnormalities at the CVJ and PF (Table) [16,43,45].…”

Section: Discussionmentioning

confidence: 88%

The post–syrinx syndrome: stable central myelopathy and collapsed or absent syrinx

2006

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Among 168 cases with neurologic findings of cervicothoracic syringomyelia and MRI findings of Chiari 1 malformation and/or underdevelopment of the posterior cranial fossa, 15 patients (9.1%) had collapsed, flat syrinxes and 14 patients (8.3%) did not have syrinxes. Both groups of patients had clinical findings of central myelopathy that had been stable for at least 3 years. Magnetic resonance imaging detected atrophy of the cervical spinal cord in both groups and spontaneous communications between the syrinx and the subarachnoid space in 3 patients of the group with collapsed syrinxes. Analysis of these results and review of the literature suggest that patients with clinical signs of syringomyelia and Chiari 1 malformation or underdeveloped posterior fossa, but with small or absent syringomyelitic cavities, have the "postsyrinx" state as a result of spontaneous collapse of distended syrinxes.

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Dysesthetic Pain in Patients with Syringomyelia

Cited by 96 publications

References 46 publications

Spinal Cord Injury: A Model of Central Neuropathic Pain

Spinal Cord Injury: A Model of Central Neuropathic Pain

Pain following spinal cord injury

The post–syrinx syndrome: stable central myelopathy and collapsed or absent syrinx

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