Diagnostics and treatment of pain in spinal cord injury

Abstract

Pain has various manifestations in spinal cord injury (SCI) that depend on multiple factors such as the affected tissue. Neuropathic pain is common, and nociceptive pain is frequently seen as a consequence of complications like overstraining of joints or bowel dysfunction and mainly presents as musculoskeletal and/or visceral pain. Both, peripheral neuropathic pain, as a result of lesions to nerve roots, and central neuropathic pain, due to lesions of the spinal cord occur in SCI. It is classified as at-level or below-level pain. Neuropathic pain, which is not or indirectly related to SCI, such as carpal tunnel syndrome, is termed "other" neuropathic pain. There is limited knowledge of the underlying mechanisms in SCI-related neuropathic pain. It often develops into a chronic condition, having a crucial impact on the patients' quality of life. Therapy of neuropathic pain includes antidepressants and anticonvulsants. Some patients experience insufficient pain relief and may experience undesirable side effects. Promising non-pharmacological therapeutic approaches beyond psychological support/therapy, like neurostimulation, are being investigated. For treatment of nociceptive pain, it is important to identify the underlying causes and to tailor the treatment individually. Its therapy may involve different approaches comprising physiotherapy, medical treatment, including spasmolytic drugs, as well as interventional treatment. This chapter will focus on the most relevant aspects of SCI-related pain, including epidemiology, impact on physical and psychosocial functioning, potentially underlying mechanisms, and important diagnostics. We will discuss the latest scientific knowledge and discuss the prediction, prevention, and treatment of pain in SCI.