Pharmacological Management of Neuropathic Pain Following Spinal Cord Injury

Abstract

Spinal cord injury (SCI) has a number of severe and disabling consequences, including chronic pain, and around 40% of patients develop persistent neuropathic pain. Pain following SCI has a detrimental impact on the patient's quality of life and is a major specific healthcare problem in its own right. Thus far, there is no cure for the pain and oral pharmaceutical intervention is often inadequate, commonly resulting in a reduction of only 20-30% in pain intensity. Neuropathic pain sensations are characterized by spontaneous persistent pain and a range of abnormally evoked responses, e.g. allodynia (pain evoked by normally non-noxious stimuli) and hyperalgesia (an increased response to noxious stimuli). Neuropathic pain following SCI may be present at or below the level of injury. Oral pharmacological agents used in the treatment of neuropathic pain act either by depressing neuronal activity, by blocking sodium channels or inhibiting calcium channels, by increasing inhibition via GABA agonists, by serotonergic and noradrenergic reuptake inhibition, or by decreasing activation via glutamate receptor inhibition, especially by blocking the NMDA receptor. At present, only ten randomized, double-blind, controlled trials have been performed on oral drug treatment of pain after SCI, the results of most of which were negative. The studies included antidepressants (amitriptyline and trazodone), antiepileptics (gabapentin, pregabalin, lamotrigine and valproate) and mexiletine. Gabapentin, pregabalin and amitriptyline showed a significant reduction in neuropathic pain following SCI. Cannabinoids have been found to relieve other types of central pain, and serotonin noradrenaline reuptake inhibitors as well as opioids relieve peripheral neuropathic pain and may be used to treat patients with SCI pain.

Sexual rehabilitation in women with spinal cord injury: a critical review of the literature

“…4,9,10 Table 3 reports medical problems correlated to SCI. 1,4,5,9,[24][25][26] Psychological issues. The process of mourning the losses brought on by injury requires psychological support because most women feel their bodies are less attractive after the spinal cord lesion.…”

A randomized trial of pregabalin in patients with neuropathic pain due to spinal cord injury

“…3 This pain is often severe and refractory to treatment, which includes anticonvulsants, antidepressants, analgesics, and antispasticity medications. [4][5][6][7] As a result, central neuropathic pain after SCI has a substantial impact on patient function, sleep, and overall quality of life. [8][9][10] Pregabalin (Lyrica; Pfizer Inc., New York, NY), an a 2 d ligand, is approved for the treatment of neuropathic pain in more than 100 countries, 11 including the treatment of central and peripheral neuropathic pain in the European Union, 12 peripheral neuropathic pain in Japan, 11 and peripheral neuropathic pain due to diabetic peripheral neuropathy or postherpetic neuralgia in the United…”

Cell Cycle Activation Contributes to Increased Neuronal Activity in the Posterior Thalamic Nucleus and Associated Chronic Hyperesthesia after Rat Spinal Cord Contusion

“…Perhaps most debilitating is the presence in most patients of chronic, spontaneous pain [7,8]. SCI pain is usually resistant to treatment [9]. In most SCI patients chronic pain first appears more than 1 year after the injury [10][11][12].…”