When a patient with complete SCI (T6- ASIA A) complains of pain (burning) in lower limbs, how can it be managed? Should exercises be modified if a person with SCI complains of central pain?
It depends if this a new symptom in an acute SCI or Chronic SCI.
In acute SCI neurogenic pain is managed with Tricyclic antidepressants like amitriptyline of Anticonvulsants like Gabapentin.
Any SCI patient c/o neurogenic pain should be investigated for other pathological causes for instances bladder related (80%) bowel related (15%) & others like syringomyelia.
Hope this helps
Best wishes
Dear Dr. Vinod,
Thanks for your inputs. However, I believe that neurogenic pain results from the pathological changes in the nervous system itself, central or peripheral, and does not involve the activation of nociceptors (bladder , bowel related etc). The effectiveness of amitriptyline in central pain has been established by Leijon and Boivie and Bowsher. I was wondering if temporal and spatial summation of sensations while administering therapy may have an effect on the pathophysiology of central pain ? Please share your views.
Regards.
I understand that neuropathic pain in SCI can also be influenced by nociceptive inputs as well as the changes in peripheral, spinal and central processing associated with SCI itself.
At some point in the management of neuropathic pain after SCI it should be explored whether there is a role for surgical interventions. These should be considered when pharmacologic and other therapies have been thoroughly tested and the patient remains with a degree of pain that is still eroding their quality of life. There are several surgical options that range from reversible with low invasiveness to more invasive procedures. These include epidural stimulation, deep brain stimulation, cortical stimulation, radiofrequency lesions of the dorsal grey matter segments based on abnormal recordings from this area at and locally above the lesion level. There are even more invasive treatments that should be reserved for unique cases.
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