Enhanced recovery of human spinothalamic function is associated with central neuropathic pain after SCI

Hari, Annegret R.; Wydenkeller, Susanne; Dokladal, Petra; Halder, Pascal

doi:10.1016/j.expneurol.2008.12.018

Cited by 37 publications

(25 citation statements)

References 15 publications

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“…This interpretation was based on their findings that the degree of enhanced pinprick sensation (reflective of STT-mediated function) over the first year after SCI was significantly related to the subsequent development and/or maintenance of NP and its intensity. Therefore, our results, together with other clinical studies, 13,33,44,45 support basic research studies in SCI proposing facilitation, disinhibition, or hyperexcitability of STT neurons as potential underlying mechanisms of NP (for a recent review see Gwak and Hulsebosch 46 ).…”

supporting

confidence: 87%

“…33 Our findings are also consistent with those from Wasner and colleagues, 44 in which only persons with SCI and NP (and not those with SCI without NP) had residual STT transmission after sensitization with three chemicals that specifically activate unmyelinated afferents (i.e., histamine, L-menthol, and capsaicin). In another study, 45 enhanced spontaneous recovery of STT function was found to be associated with the development of NP. This interpretation was based on their findings that the degree of enhanced pinprick sensation (reflective of STT-mediated function) over the first year after SCI was significantly related to the subsequent development and/or maintenance of NP and its intensity.…”

mentioning

confidence: 86%

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Decreased Spinothalamic and Dorsal Column Medial Lemniscus-Mediated Function Is Associated with Neuropathic Pain after Spinal Cord Injury

Cruz-Almeida

Felix

Martinez‐Arizala

et al. 2012

Journal of Neurotrauma

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Neuropathic pain (NP) after spinal cord injury (SCI) can significantly and negatively affect quality of life and is often refractory to currently available treatments. In order to find more effective therapeutic avenues, it would be helpful to identify the primary underlying pathophysiological mechanisms in each individual. The aim of the present study was to assess the relationship between the presence and severity of NP after SCI and measures of somatosensory function mediated via the dorsal column medial lemniscal (DCML) pathway and the spinothalamic tract (STT). Vibratory, mechanical, thermal, and pain thresholds measured in areas at and below the neurological level of injury (LOI) in persons with SCI and NP (SCI-NP, n=47) and in persons with SCI without NP (SCI-noNP, n=18) were normalized to data obtained from able-bodied pain-free control subjects (A-B, n=30). STT-mediated function at and below the LOI was significantly impaired in both SCI groups compared with A-B controls (p<0.001), but not significantly different between the two SCI groups (NP vs. no-NP). In contrast, the SCI-NP group had significantly greater impairment of DCML-mediated function at the LOI, as reflected by greater vibratory detection deficits (z=-3.89±0.5), compared with the SCI-noNP group (z=-1.95±0.7, p=0.034). Within the SCI-NP group, NP severity was significantly associated with increased thermal sensitivity below the LOI (r=0.50, p=0.038). Our results suggest that both impaired STT and DCML-mediated function are necessary for the development of NP after SCI. However, within the SCI-NP group, greater NP severity was associated with greater sensitivity to thermal stimuli below the LOI. This finding concurs with other studies suggesting that STT damage with some sparing is associated with NP.

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supporting

confidence: 87%

mentioning

confidence: 86%

Decreased Spinothalamic and Dorsal Column Medial Lemniscus-Mediated Function Is Associated with Neuropathic Pain after Spinal Cord Injury

Cruz-Almeida

Felix

Martinez‐Arizala

et al. 2012

Journal of Neurotrauma

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“…Moreover, these dermatomes are considered meaningful to the mechanism of central pain. 23,36,37 Additional locations included dermatomes L3, L4, and L5 for all the patients regardless of their sensory level. We choose these dermatomes because previous studies have shown that central pain commonly occurs in these regions regardless of the injury level.…”

Section: The Historical-prospective Studymentioning

confidence: 99%

“…PP scores were found to predict motor recovery after SCI. 21,22 More importantly, Hari and colleagues 23 found a tendency towards lower PP scores among SCI patients with acute CP, compared with pain-free patients. Although less precise than psychophysical and electrophysiological measurements, PP and LT scores provide an approximation of the function of the spinothalamic and dorsal column function, respectively, [24][25][26][27] which are particularly relevant to CP because: 1) the spinothalamic system is impaired among individuals already suffering from CP 6,8,24,[28][29][30][31][32][33][34] and 2) an imbalance between the function of the spinothalamic and dorsal column systems was suggested as mechanism of CP.…”

Section: Introductionmentioning

confidence: 96%

Predicting the Risk for Central Pain Using the Sensory Components of the International Standards for Neurological Classification of Spinal Cord Injury

Levitan

Zeilig

Bondi

et al. 2015

Journal of Neurotrauma

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Central neuropathic pain (CP) after spinal cord injury (SCI) is excruciating and difficult to manage. Pre-emptive treatment could be initiated in patients at risk for CP providing that it can be predicted. A combination of psychophysical tests could predict CP, but the process necessitates sophisticated equipment and constant monitoring. A simple predictive tool for CP is required. The aim of this study was to test the predictability for CP of the sensory component of the International Standards for Neurological Classification of Spinal Cord Injury (SC-ISNCSCI), routinely performed on all SCI patients. In an historical-prospective study, the SC-ISNCSCI and background variables were extracted from medical records of 115 SCI patients. In a prospective study, 20 SCI patients underwent the SC-ISNCSCI at admission and were followed-up for 12 months. In both studies, pinprick (PP) and light touch (LT) scores from the SC-ISNCSCI and the difference between them (LT-PP) were compared between those who eventually developed CP and those who did not. Heat-pain and touch thresholds were measured and correlated with the SC-ISNCSCI to test its validity. In both studies, patients who developed CP had, prior to CP, lower PP than LT scores, and lower PP scores than those who did not develop CP. At-level delta LT-PP score>1 best predicted CP; the odds of developing CP with LT-PP>1 was 24.4 times that of the reverse category (LT-PP<1). Heat-pain and touch thresholds significantly correlated with PP and LT. We conclude that the SC-ISNCSCI can be used as a clinical biomarker of CP with high probability.

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“…4 Recently, improvement of pinprick sensitivity below both complete and incomplete SCI 5 and the description of evoked pain in response to topical application of capsaicin also applied below clinically complete SCI 6 have demonstrated the potential of further developing sensory tests for NP clinical research. We hypothesized that the role of IH on residual ascending pain pathway function and NP perception could be better investigated with the application of tonic thermal test stimuli.…”

Section: Introductionmentioning

confidence: 99%

Sensory function after cavernous haemangioma: a case report of thermal hypersensitivity at and below an incomplete spinal cord injury

et al. 2012

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Study design: Case report of a 42-year-old woman with non-evoked pain diagnosed with a cavernous C7-Th6 spinal haemangioma. Objectives: To assess the effect of intramedullary haemorrhage (IH) on nociception and neuropathic pain (NP) at and below an incomplete spinal cord injury (SCI). Setting: Sensorimotor Function Group, Hospital Nacional de Parapléjicos de Toledo (HNPT). Methods: T2*-susceptibility weighted image (SWI) magnetic resonance imaging (MRI) of spinal haemosiderin and a complete pain history were performed 8 months following initial dysaesthesia complaint. Thermal pain thresholds were assessed with short 1 s stimuli, while evidence for central sensitization was obtained with psychophysical electronic Visual Analogue Scale rating of tonic 10 s 3 1C and 48 1C stimuli, applied at and below the IH. Control data were obtained from 10 healthy volunteers recruited from the HNPT. Results: Non-evoked pain was present within the Th6 dermatome and lower legs. T2*-SWI MRI imaging detected extensive haemosiderin-rich IH (C7-Th5/6 spinal level). Cold allodynia was detected below the IH (left L5 dermatome) with short thermal stimuli. Tonic thermal stimuli applied to the Th6, Th10 and C7 dermatomes revealed widespread heat and cold allodynia. Conclusion: NP was diagnosed following IH, corroborated by an increase in below-level cold pain threshold with at-and below-level cold and heat allodynia. Psychophysical evidence for at-and below-level SCI central sensitization was obtained with tonic thermal stimuli. Early detection of IH could lead to better management of specific NP symptoms, an appreciation of the role of haemorrhage as an aggravating SCI physical factor, and the identification of specific spinal pathophysiological pain mechanisms.

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Enhanced recovery of human spinothalamic function is associated with central neuropathic pain after SCI

Cited by 37 publications

References 15 publications

Decreased Spinothalamic and Dorsal Column Medial Lemniscus-Mediated Function Is Associated with Neuropathic Pain after Spinal Cord Injury

Decreased Spinothalamic and Dorsal Column Medial Lemniscus-Mediated Function Is Associated with Neuropathic Pain after Spinal Cord Injury

Predicting the Risk for Central Pain Using the Sensory Components of the International Standards for Neurological Classification of Spinal Cord Injury

Sensory function after cavernous haemangioma: a case report of thermal hypersensitivity at and below an incomplete spinal cord injury

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