Neuropathic pain and spasticity: intricate consequences of spinal cord injury

Finnerup, Nanna Brix

doi:10.1038/sc.2017.70

Cited by 90 publications

(75 citation statements)

References 67 publications

(72 reference statements)

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“…In the current survey, both the reported severity of the balance and gait problems, fear of falling, and the high prevalence of falls and fall-related injuries indicate that safe and efficient postural and ambulatory control is a major problem in people with pure HSP. The observed proportion of 67% of people who reported at least one fall per year seems to be comparable to other patients with spastic paraparesis caused by, for instance, multiple sclerosis, tropical spastic paraparesis or spinal cord injury of whom 50-75% report at least one fall per year [21][22][23][24][25][26][27][28][29][30]. Unfortunately, the present data do not allow us to make inferences on the effect of walking aids on falls, but many participants reported the use of different types of walking aids to increase their walking distance.…”

Section: Balance Gait and Fallssupporting

confidence: 62%

“…From our recent qualitative study it became clear that spasticity and muscle stiffness impact on physical fitness, while the high levels of attention needed to cope with balance and gait problems seem to cause mental fatigue [16]. Generally, fatigue and pain are serious problems in many types of chronic neurological disorders such as spinal cord injury, stroke, Parkinson's disease, multiple sclerosis, and neuromuscular disease, which require specific clinical attention and treatment [30,[38][39][40][41][42]. Our results indicate that people with HSP form no exception to this rule, and probably remain undertreated in these respects.…”

Section: Muscular and Non-motor Symptomsmentioning

confidence: 99%

“…The observed odds ratio of 0.944 implies that, with every year, the chance of being a walker without walking aids decreases by a factor 0.944. Over 30 years, the chance of being a walker without aids would thus decrease to a mere 17.8% (0.944 30 ). Experienced problems with gait-related activities also appeared to be a strong predictor of the inability to walk without aids.…”

Section: Predicting Unsupported Walking Capacity and Fallingmentioning

confidence: 99%

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Experienced complaints, activity limitations and loss of motor capacities in patients with pure hereditary spastic paraplegia: a web-based survey in the Netherlands

Lith

Kerstens

Bemd

et al. 2020

Orphanet J Rare Dis

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Background: Hereditary spastic paraplegia (HSP) is a group of inherited disorders characterized by progressive spastic paresis of the lower limbs. Treatment is often focused on reducing spasticity and its physical consequences. To better address individual patients' needs, we investigated a broad range of experienced complaints, activity limitations, and loss of motor capacities in pure HSP. In addition, we aimed to identify patient characteristics that are associated with increased fall risk and/or reduced walking capacity. Methods: We developed and distributed an HSP-specific online questionnaire in the Netherlands. A total of 109 out of 166 questionnaires returned by participants with pure HSP were analyzed. Results: Participants experienced the greatest burden from muscle stiffness and limited standing and walking activities, while 72% reported leg and/or back pain. Thirty-five and 46% reported to use walking aids (e.g. crutches) indoors and outdoors, respectively; 57% reported a fall incidence of at least twice a year ('fallers'); in 51% a fall had led to an injury at least once; and 73% reported fear of falling. Duration of spasticity and incapacity to rise from the floor were positively associated with being a 'faller', whereas non-neurological comorbidity and wheelchair use were negatively associated. Higher age, experienced gait problems, not being able to stand for 10 min, and incapacity to open a heavy door showed a negative association with being a 'walker without aids' (> 500 m). Conclusions: Our results emphasize the large impact of spastic paraparesis on the lives of people with pure HSP and contribute to a better understanding of possible targets for rehabilitation.

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Section: Balance Gait and Fallssupporting

confidence: 62%

Section: Muscular and Non-motor Symptomsmentioning

confidence: 99%

Section: Predicting Unsupported Walking Capacity and Fallingmentioning

confidence: 99%

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Experienced complaints, activity limitations and loss of motor capacities in patients with pure hereditary spastic paraplegia: a web-based survey in the Netherlands

Lith

Kerstens

Bemd

et al. 2020

Orphanet J Rare Dis

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“…Painful spasticity is generally attributed to the activation of skeletomuscular nociceptors during muscle contractions, in part because spasmolytic drugs can decrease musculoskeletal pain . It is possible that in some cases painful spasticity may be partially dependent on mechanisms similar to neuropathic pain . In fact, persons who have neuropathic pain after SCI experience more spasticity than persons with SCI who have non‐neuropathic pain .…”

Section: Discussionmentioning

confidence: 99%

Spasticity and Pain after Spinal Cord Injury: Impact on Daily Life and the Influence of Psychological Factors

Tibbett

Field-Fote

Thomas

et al. 2019

PM&R

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Background Spasticity and pain frequently co‐occur in persons with spinal cord injury (SCI), yet, how these sequelae interact in daily life is unclear. Additionally, little is known about how psychological factors relate to the perception of spasticity and its impacts on daily life. Objectives (1) Characterize relationships between spasticity and chronic pain with regard to perceived severity, difficulty dealing, and life interference. (2) Determine the extent to which perceived spasticity severity and physiological, psychological, and pain‐related factors contribute to impacts of spasticity on daily life (difficulty in dealing, life interference). (3) Determine the effects of painful spasticity on aspects of chronic pain and spasticity (severity, life interference, interference with sleep, and spasm duration). Design Observational study. Setting University laboratory. Participants Twenty participants with SCI and lower extremity spasticity. Methods Measures included International SCI Pain Basic Data Set, Pain and Spasticity Inventories, Difficulty Dealing with Pain/Spasticity, SCI‐Spasticity Evaluation Tool, Connor‐Davidson Resilience and Moorong Self‐Efficacy Scales, Spinal Cord Assessment Tool for Spastic Reflexes, spasm duration, and injury‐related and demographic factors. Bivariate correlations, multiple regression analyses, and pairwise comparisons were performed. Results Spasticity and chronic pain were directly related, with respect to perceived severity, difficulty dealing, and life interference (rho = 0.514‐0.673, P < .05). Shorter injury duration, greater perceived spasticity severity, and greater difficulty dealing with pain explained 61% of variance in difficulty dealing with spasticity. Greater perceived spasticity severity and lower resilience explained 72% of variance in life interference of spasticity. Spasm duration was not significantly associated with perceived spasticity severity. Participants with painful spasticity had significantly greater chronic pain severity (P = .02) and sleep‐related impact of spasticity (P = .03) than participants without painful spasticity. Conclusions Perceived severity of spasticity, injury duration, ability to deal with chronic pain, resilience, and painful spasms appear to play important roles in the negative impacts of spasticity on life after SCI. Level of Evidence III.

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“…116,117 Additionally, patients suffer from spasticity, which also results in pain. 118 Baclofen is the primary spasmolytic used in management, which may be administered orally or through an intrathecal pump. Early oral baclofen administration (1 day after SCI) has been reported; however, further study is warranted to determine the efficacy and appropriate timing of its use in the ICU.…”

Section: Recovery and Rehabilitationmentioning

confidence: 99%

Critical Care Management of Acute Spinal Cord Injury—Part II: Intensive Care to Rehabilitation

Sacino

Rosenblatt

2019

Journal of Neuroanaesthesiology and Critical Care

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Spinal cord injury is devastating to those affected due to the loss of motor and sensory function, and, in some cases, cardiovascular collapse, ventilatory failure, and bowel and bladder dysfunction. Primary trauma to the spinal cord is exacerbated by secondary insult from the inflammatory response to injury. Specialized intensive care of patients with acute spinal cord injury involves the management of multiple systems and incorporates evidence-based practices to reduce secondary injury to the spinal cord. Patients greatly benefit from early multidisciplinary rehabilitation for neurologic and functional recovery. Treatment of acute spinal cord injury may soon incorporate novel molecular agents currently undergoing clinical investigation to assist in neuroprotection and neuroregeneration.

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Neuropathic pain and spasticity: intricate consequences of spinal cord injury

Cited by 90 publications

References 67 publications

Experienced complaints, activity limitations and loss of motor capacities in patients with pure hereditary spastic paraplegia: a web-based survey in the Netherlands

Experienced complaints, activity limitations and loss of motor capacities in patients with pure hereditary spastic paraplegia: a web-based survey in the Netherlands

Spasticity and Pain after Spinal Cord Injury: Impact on Daily Life and the Influence of Psychological Factors

Critical Care Management of Acute Spinal Cord Injury—Part II: Intensive Care to Rehabilitation

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