Spinal Cord Injury, Neuropathic Pain

Full Title: Management of Chronic Neuropathic Pain Following Traumatic Spinal Cord Injury

September 2001

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Structured Abstract

Objectives: To evaluate:

1. The measurement of central neuropathic pain (CNP) after traumatic spinal cord injury (TSCI).
2. The prevalence of acute and chronic CNP.
3. Predictive factors for chronic CNP.
4. The effectiveness and safety of various interventions for CNP.

Search Strategy: Studies were identified by searching MEDLINE®, EMBASE, and PsycINFO (to May 2000); CINAHL, HEALTHStar, and Sociological Abstracts (to November 1999); the Cochrane Library (issue 4, 1999); reference lists of eligible articles found in the searches; and personal files of advisory panel members.

Selection Criteria: Studies about the cause, management, or measurement of CNP were included. Exclusion criteria were participants without TSCI or CNP, children younger than 13 years, or inability to determine whether chronic pain was central and neuropathic.

Data Collection and Analysis: Two reviewers independently extracted data for all studies except case reports. One reviewer extracted case report data, which was checked by another. Disagreements were resolved by consensus. The quality of data was assessed. Data were not pooled because clinical heterogeneity existed across studies, outcome measurements were inconsistent, studies had low methodological quality, and data reporting was incomplete.

Main Results: 132 unique studies (6 randomized controlled trials and 126 observational studies, including 47 case series and at least 56 single or multiple case reports) met the selection criteria. Few studies evaluated the management of CNP following TSCI in women; and no studies evaluated adolescents only, the role of treatment algorithms, or multidisciplinary approaches. Only two studies evaluated self-management strategies in cases of CNP following TSCI.

• Diagnosis, assessment and natural history: No discriminative or evaluative measurement instruments have been adequately investigated with respect to psychometric measurement properties in this setting.
• Pharmacological interventions: Little research has been done. The few studies available have such poor methods that it was not possible to evaluate interventions. It appears that local anesthetics, opioids, and clonidine given spinally may be effective in relieving CNP following TSCI, but better research is needed.
• Spinal cord and deep brain stimulation techniques: The studies had similar deficiencies to those described above. The limited evidence available suggests that spinal cord stimulation has a variable rate of early success and a low rate of long-term effectiveness. Deep brain stimulation has a low rate of early success and an even lower long-term success rate, coupled with significant adverse events.
• Dorsal root entry zone (DREZ) lesions and other surgical interventions: All studies on DREZ showed high rates of success but had poorly defined or no eligibility criteria, included no control groups, and did not report adequately the severity of adverse effects.

Conclusions: This report describes rigorous systematic reviews on the measurement and management of CNP after TSCI in adults and adolescents. The research on this topic is in its infancy. This report describes the limitations of the available evidence and provides recommendations for future research.

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Management of Chronic Neuropathic Pain Following Traumatic Spinal Cord Injury

• Summary (Publication No. 01-E062).
• Evidence Report (Publication No. 01-E063).

Evidence-based Practice Center: McMaster University
Topic Nominator: Consortium for Spinal Cord Medicine

Current as of September 2001