Neuropathic pain following spinal cord injury pain: mechanisms and treatment

Patients suffering from a spinal cord injury (SCI) face functional loss and physical dependence, and historically most SCI research has focused on locomotor recovery and bladder and bowel dysfunction. We now realize that chronic pain may have a major impact on the quality of life in patients with SCI. The purpose of this paper is to review the current knowledge of mechanisms and treatment of neuropathic pain following SCI and to highlight some of the obstacles for improved pain treatment. Several preclinical models mimic human spinal cord injury reasonably well, but the interpretation of pain assessment and its translation into human SCI pain is not always straightforward and may be biased by other consequences of a spinal injury such as spasms and anxiety. Both preclinical and human studies suggest that a SCI causes major structural and biochemical changes in widespread areas of the central nervous system. The causal relationship between these changes and at- and below-level SCI pain needs to be further addressed. Neuropathic SCI pain is difficult to treat but evidence supports a treatment algorithm similar to what is proposed for peripheral neuropathic pain. As for any chronic pain condition, a biopsychosocial framework is necessary to understand the various aspects of pain interference and associated comorbidities such as anxiety and depression and to improve treatment.