Analysis of neuropathic pain after spinal cord injury

Longstanding neuropathic pain is a challenge in spinal cord injury (SCI) rehabilitation. Once established it is difficult to treat successfully. Neuropathic pain has a negative influence on quality of life and on the outcome of rehabilitation. The prevalence of neuropathic pain after SCI varies in different studies. However, pain in adults with spina bifida (SB) seems to be a minor problem.

The aim of this thesis was to study the prevalence of neuropathic pain in patients with traumatic and non-traumatic SCI and in adults with SB and to relate neuropathic pain to completeness and level of injury, gender, age at time of lesion and to study the impact of neuropathic pain on daily life. Another aim was to study the neurological and functional outcome as well as prevalence of neuropathic pain in patients with central cord syndrome (CCS). Patients with SCI who had their yearly check-up at the Spinalis outpatient clinic between 1995 and 2000 were included in the study. Data were gathered from the checkup and include ASIA impairment scale, the neurological level, and the impact of neuropathic pain on daily life.

Patients with CCS rehabilitated at the spinal unit of Florence, Italy during the years 1996- 2002 were included. A follow-up visit was performed at least 18 months after discharge. Data were gathered from the examination at admission and discharge from hospital and at follow up. Studied data included ASIA impairment scale, neurological level, WISCI (walking ability), FIM (Functional Independence Measure), spasticity and neuropathic pain. The patients were divided in age groups according to age at the time of injury. Longstanding neuropathic pain was present in 40% and in 38% of the patients with traumatic and non-traumatic SCI, respectively, and in 11% of adults with SB. In the traumatic group neuropathic pain was more common in adults injured late in life. Females in the non-traumatic group had more often below level pain than males. In both traumatic and non-traumatic SCI neurological level and completeness of injury had no relation to the development of neuropathic pain. When pain was present it influenced daily life in the majority of cases.

Patients with CCS over 65 years of age at the time of injury had impaired neurological and functional recovery and more often experienced neuropathic pain (60%) than individuals injured earlier in life (20%). Spasticity was equally common in individuals injured late and early in life. It is concluded that neuropathic pain is common in traumatic and non-traumatic SCI, and in patients with CCS but is less frequent in adults with SB. Patients with traumatic CCS injured at a young age had better neurological and functional outcome than patients injured later in life.

List of scientific papers

I. Werhagen L, Budh CN, Hultling C, Molander C (2004). Neuropathic pain after traumatic spinal cord injury--relations to gender, spinal level, completeness, and age at the time of injury. Spinal Cord. 42(12): 665-73.
https://pubmed.ncbi.nlm.nih.gov/15289801

II. Werhagen L, Hultling C, Molander C (2007). The prevalence of neuropathic pain after non-traumatic spinal cord lesion. Spinal Cord. 45(9): 609-15. Epub 2006 Dec 12
https://pubmed.ncbi.nlm.nih.gov/17160075

III. Werhagen L (2008). Neuropathic and nociceptive pain in adults with spina bifida, relations to gender, completeness of injury, the neurological level and hydrocephalus. [Submitted]

IV. Aito S, DAndrea M, Werhagen L, Farsetti L, Cappelli S, Bandini B, Di Donna V (2007). Neurological and functional outcome in traumatic central cord syndrome. Spinal Cord. 45(4): 292-7. Epub 2006 Jun 13
https://pubmed.ncbi.nlm.nih.gov/16773038