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Neuropathic Pain in Spinal Cord Injuries

Year 2023, Volume: 6 Issue: 1, 140 - 146, 30.04.2023
https://doi.org/10.36516/jocass.1243810

Abstract

Aim: Spinal cord injury (SCI) is a destructive condition causing additional physical, psychological, and social function disorders. Neuropathic pain (NP) following SCI is a common and challenging problem to treat. The addition of the NP following SCI increases the impairment of the sleep patterns, moods, and daily life activities of the patients. Treatment of NP following SCI is often difficult and often requires a long time to respond to treatment. The study aimed to investigate the neuropathic pain condition in patients with SCI.
Methods: The study included 52 patients with spinal cord injuries. Including the demographics and clinical characteristics, The Visual Analog Scale (VAS) was used to define the intensity of the pain, and a self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) was used to assess the neuropathic symptoms and signs. The cases under the age of 18, and over 65 with conditions that might have neuropathic origins, ones with dermatological diseases in the symptomatic regions, and other clinical issues that may cause immobility besides SCI, were not included in the study.
Results:The mean age was 42,25±18,12 years. The median scores of VAS and S-LANSS were 6 (0-10) and 11 (0-24), respectively. The majority were male, ASIA A, and paraplegic (63.5%, 67.3%, and 67.3%, respectively). The rates of patients on pregabalin and gabapentin were 30.8% and 19.2%, respectively. The VAS scores of patients with a higher probability of neuropathic pain (S-LANSS≥12) were significantly increased (7 (4-10) vs 3,5 (0-9), p<0.001). There were no significant differences in terms of age and gender.
Conclusions: Among SCI patients, the frequency of NP detected by using S-LANSS were increased. Therefore, patients with SCI might require a more careful examination regarding neuropathic pain and thus receive appropriate treatments in routine clinical practice.

Supporting Institution

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References

  • 1. Sekhon L, Fehlings MG. Epidemiology, demographics and pathophysiology of acute spinal cord injury. Spine 2001;26; S2-S12.
  • 2. Dursun E, Çakıcı A. Medulla Spinalis Yaralanmaları. Oğuz H (editör). Tıbbi Rehabilitasyon. İstanbul: Nobel Tıp 1. Baskı, 1995.
  • 3. Defrin R, Ohry A, Blumen N, et al. Characterization of chronic pain and somatosensory function in spinal cord injury subjects. Pain 2001;89(2-3):253–63.
  • 4. Vall J, Costa CM, Santos Tde J, et al. Neuropathic pain characteristics in patients from Curitiba (Brazil) with spinal cord injury. Arq Neuropsiquiatr 2011;69(1):64-8.
  • 5. Werhagen L, Budh CN, Hultling C, et al. Neuropathic pain after traumatic spinal cord injury-relations to gender, spinal level, completeness, and age at the time of injury. Spinal Cord 2004;42(12):665-73.
  • 6. Afsar SI, Cosar SNS, YemiSKY OU, et al. Neuropathic pain in patients with spinal cord injury. Int J Phys Med Rehabil 2014;2(228):2-5.
  • 7. Ataoğlu E, Tiftik T, Kara M, et al. Effects of chronic pain on quality of life and depression in patients with spinal cord injury. Spinal Cord 2013;51(1):23-6
  • 8. Siddall PJ, Loeser JD. Pain following spinal cord injury. Spinal Cord 2001;39(2):63- 73.
  • 9. Siddall PJ. Management of neuropathic pain following spinal cord injury: now and in the future. Spinal Cord 2009;47(5):352-9.
  • 10. Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008;70(18):1630-5.
  • 11. Finnerup NB, Johannesen IL, Fuglsang-Frederiksen A, et al. Sensory function in spinal cord injury patients with and without central pain. Brain 2003;126(1):57-70.
  • 12. Widerström-Noga EG, Turk DC. Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics. Spinal Cord 2003;41(11):600-9.
  • 13. Warms CA, Turner JA, Marshall HM, et al. Treatments for chronic pain associated with spinal cord injuries: many are tried, few are helpful. Clin J Pain 2002;18(3):154-63.
  • 14. Cardenas DD, Jensen MP. Treatments for chronic pain in persons with spinal cord injury: A survey study. J Spinal Cord Med 2006;29(2):109-17.
  • 15. Störmer S, Gerner HJ, Grüninger W, et al. Chronic pain/dysaesthesiae in spinal cord injury patients: results of a multicentre study. SpinalCord 1997;35(7):446- 55.
  • 16. Westgren N, Levi R. Quality of life and traumatic spinal cord injury. Arch Phys Med Rehabil 1998;79(11):1433-9.
  • 17. Baastrup C, Finnerup NB. Pharmacological management of neuropathic pain following spinal cord injury. CNS Drugs 2008;22(6):455-75.
  • 18. Haanpää M, Attal N, Backonja M, et al. NeuPSIG guidelines on neuropathic pain assessment. Pain 2011;152(1):14-27.
  • 19. Norrbrink Budh C, Lund I, Ertzgaard P, et al.Pain in a Swedish spinal cord injury population. Clin Rehabil 2003;17: 685-690.
  • 20. Siddall PJ, Loeser JD. Pain following spinal cord injury. Spinal Cord 2001;39: 63-73.
  • 21. Celik EC, Erhan B, Lakse E. The clinical characteristics of neuropathic pain in patients with spinal cord injury. Spinal Cord 2012;50: 585-589.
  • 22. Dominguez CA, Ström M, Gao T, et al.Genetic and sex influence on neuropathic pain-like behaviour after spinal cord injury in the rat. Eur J Pain 2012;16(10):1368-77.
  • 23. Savaş F, Erhan B. Medulla spinalis yaralanması sonrası nöropatik ağrı değerlendirilmesi. Uzmanlık tezi. İstanbul, Sağlık Bakanlığı İstanbul Fizik Tedavi Rehabilitasyon Eğitim ve Araştırma Hastanesi 1. Klinik, 2009.
  • 24. Werhagen L, Budh CN, Hultling C, et al.Neuropathic pain after traumatic spinal cord injury--relations to gender, spinal level, completeness, and age at the time of injury. Spinal Cord 2004;42: 665-673.
  • 25. Siddall PJ, McClelland JM, Rutkowski SB, et al. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain 2003;103: 249-257.
  • 26. Teixeira MJ, Paiva WS, Assis MS, et al. Neuropathic pain in patients with spinal cord injury: report of 213 patients. Arq Neuropsiquiatr 2013;71(9A):600-3.

Spinal Kord Yaralanmalarında Nöropatik Ağrı

Year 2023, Volume: 6 Issue: 1, 140 - 146, 30.04.2023
https://doi.org/10.36516/jocass.1243810

Abstract

ÖZET
Giriş
Spinal kord yaralanması (SKY); fiziksel, psikolojik ve sosyal fonksiyon bozukluklarına neden olabilen yıkıcı bir hastalıktır. SKY sonrası nöropatik ağrı (NPA) sık karşılaşılan komplikasyonlardandır ve SKY sonrası oluşan tedavisi en zor problemlerden biridir. SKY sonrası fonksiyon kayıplarına NPA’nın da eklenmesiyle hastaların uyku düzenleri, duygu durumları ve günlük yaşam aktiviteleri olumsuz etkilenir. SKY sonrası görülen NPA tedavisi çoğu zaman zordur ve tedaviye yanıt almak da uzun zaman alabilir. Bu çalışmada SKY olan hastalarda nöropatik ağrı durumu araştırılmıştır.
Materyal ve Metod
Spinal kord yaralanmalı 52 hasta çalışmaya dahil edildi. Hastaların demografik ve klinik özellikleri incelendi. Ağrının şiddetini değerlendirmek için Vizuel Analog Skala( VAS), nöropatik ağrıyı tanımlamak ve değerlendirmek için S-LANSS ölçeği kullanıldı. 18 yaş altı, 65 yaş üstü diğer nöropati kaynağı olabilecek hastalığı bulunanlar , semptomatik bölgede herhangi bir ek cilt hastalığı bulunanlar, SKY dışında immobiliteye neden olan diğer hastalıkları olanlar çalışmaya dahil edilmedi.
Bulgular
Hastaların yaş ortalaması 42,25±18,12 yıl iken, VAS ve S-Lanns skoru median değerleri [sırasıyla 6 (0-10) ve 11 (0-24)] olarak saptandı. Hastaların %63,5’i erkek, %67,3’ü ASİA A, %67,3’ü paraplejikti. Hastaların %30,8’inin pregabalin, %19,2’sinin ise gabapentin kullandığı tespit edildi. Nöropatik ağrı olasılığı yüksek (S-lanns ≥12) olan hastalarda VAS skorlarının istatistiksel olarak anlamlı şekilde yüksek olduğu [7 (4-10) vs 3,5 (0-9), p<0.001] saptandı, bununla birlikte yaş ve cinsiyete göre anlamlı fark saptanmadı.
Sonuç
SKY hastalarda S-LANSS anketi ile belirlenen NA sıklığının yüksek olduğu bulundu. Bu nedenle rutin klinikte SKY ‘lı hastalar nöropatik ağrı varlığı açısından da dikkatle muayene edilmeli ve uygun tedaviler verilmelidir.

Anahtar Kelimeler : Spinal Kord Yaralanması, Nöropatik Ağrı, S-LANSS
Background
Spinal cord injury (SCI) is a destructive condition causing additional physical, psychological and social function disorders. Neuropathic pain (NP) following SCI is a common and challenging problem to treat. The addition of the NP following SCI increases the impairment of the sleep patterns, moods, and daily life activities of the patients. Treatment of NP following SCI is often difficult and often requires a long time to respond to treatment. The study aimed to investigate the neuropathic pain condition in patients with SCI.
Material and Methods
The study included 52 patients with spinal cord injuries. Including the demographics and clinical characteristics, The Visual Analog Scale (VAS) was used to define the intensity of the pain and a self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) was used to assess the neuropathic symptoms and signs. The cases under the age of 18, and over the age of 65 with conditions that might have neuropathic origins, having dermatological diseases in the symptomatic region, and other clinical issues that may cause immobility besides SCI, were not included in the study.
Results
The mean age was 42,25±18,12 years. The median scores of VAS and S-LANSS were 6 (0-10) and 11 (0-24), respectively. The majority were male, ASIA A, and paraplegic (63.5%, 67.3%, and 67.3%, respectively). The rates of patients on pregabalin and gabapentin were 30.8% and 19.2%, respectively. The VAS scores of patients with a higher probability of neuropathic pain (S-LANSS≥12) were significantly increased (7 (4-10) vs 3,5 (0-9), p<0.001). There were no significant differences in terms of age and gender.
Conclusion
Among SCI patients, the frequency of NP detected by using S-LANSS was increased. Therefore, patients with SCI might require a more careful examination regarding neuropathic pain and thus receive appropriate treatments in routine clinical practice.

References

  • 1. Sekhon L, Fehlings MG. Epidemiology, demographics and pathophysiology of acute spinal cord injury. Spine 2001;26; S2-S12.
  • 2. Dursun E, Çakıcı A. Medulla Spinalis Yaralanmaları. Oğuz H (editör). Tıbbi Rehabilitasyon. İstanbul: Nobel Tıp 1. Baskı, 1995.
  • 3. Defrin R, Ohry A, Blumen N, et al. Characterization of chronic pain and somatosensory function in spinal cord injury subjects. Pain 2001;89(2-3):253–63.
  • 4. Vall J, Costa CM, Santos Tde J, et al. Neuropathic pain characteristics in patients from Curitiba (Brazil) with spinal cord injury. Arq Neuropsiquiatr 2011;69(1):64-8.
  • 5. Werhagen L, Budh CN, Hultling C, et al. Neuropathic pain after traumatic spinal cord injury-relations to gender, spinal level, completeness, and age at the time of injury. Spinal Cord 2004;42(12):665-73.
  • 6. Afsar SI, Cosar SNS, YemiSKY OU, et al. Neuropathic pain in patients with spinal cord injury. Int J Phys Med Rehabil 2014;2(228):2-5.
  • 7. Ataoğlu E, Tiftik T, Kara M, et al. Effects of chronic pain on quality of life and depression in patients with spinal cord injury. Spinal Cord 2013;51(1):23-6
  • 8. Siddall PJ, Loeser JD. Pain following spinal cord injury. Spinal Cord 2001;39(2):63- 73.
  • 9. Siddall PJ. Management of neuropathic pain following spinal cord injury: now and in the future. Spinal Cord 2009;47(5):352-9.
  • 10. Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008;70(18):1630-5.
  • 11. Finnerup NB, Johannesen IL, Fuglsang-Frederiksen A, et al. Sensory function in spinal cord injury patients with and without central pain. Brain 2003;126(1):57-70.
  • 12. Widerström-Noga EG, Turk DC. Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics. Spinal Cord 2003;41(11):600-9.
  • 13. Warms CA, Turner JA, Marshall HM, et al. Treatments for chronic pain associated with spinal cord injuries: many are tried, few are helpful. Clin J Pain 2002;18(3):154-63.
  • 14. Cardenas DD, Jensen MP. Treatments for chronic pain in persons with spinal cord injury: A survey study. J Spinal Cord Med 2006;29(2):109-17.
  • 15. Störmer S, Gerner HJ, Grüninger W, et al. Chronic pain/dysaesthesiae in spinal cord injury patients: results of a multicentre study. SpinalCord 1997;35(7):446- 55.
  • 16. Westgren N, Levi R. Quality of life and traumatic spinal cord injury. Arch Phys Med Rehabil 1998;79(11):1433-9.
  • 17. Baastrup C, Finnerup NB. Pharmacological management of neuropathic pain following spinal cord injury. CNS Drugs 2008;22(6):455-75.
  • 18. Haanpää M, Attal N, Backonja M, et al. NeuPSIG guidelines on neuropathic pain assessment. Pain 2011;152(1):14-27.
  • 19. Norrbrink Budh C, Lund I, Ertzgaard P, et al.Pain in a Swedish spinal cord injury population. Clin Rehabil 2003;17: 685-690.
  • 20. Siddall PJ, Loeser JD. Pain following spinal cord injury. Spinal Cord 2001;39: 63-73.
  • 21. Celik EC, Erhan B, Lakse E. The clinical characteristics of neuropathic pain in patients with spinal cord injury. Spinal Cord 2012;50: 585-589.
  • 22. Dominguez CA, Ström M, Gao T, et al.Genetic and sex influence on neuropathic pain-like behaviour after spinal cord injury in the rat. Eur J Pain 2012;16(10):1368-77.
  • 23. Savaş F, Erhan B. Medulla spinalis yaralanması sonrası nöropatik ağrı değerlendirilmesi. Uzmanlık tezi. İstanbul, Sağlık Bakanlığı İstanbul Fizik Tedavi Rehabilitasyon Eğitim ve Araştırma Hastanesi 1. Klinik, 2009.
  • 24. Werhagen L, Budh CN, Hultling C, et al.Neuropathic pain after traumatic spinal cord injury--relations to gender, spinal level, completeness, and age at the time of injury. Spinal Cord 2004;42: 665-673.
  • 25. Siddall PJ, McClelland JM, Rutkowski SB, et al. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain 2003;103: 249-257.
  • 26. Teixeira MJ, Paiva WS, Assis MS, et al. Neuropathic pain in patients with spinal cord injury: report of 213 patients. Arq Neuropsiquiatr 2013;71(9A):600-3.
There are 26 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Articles
Authors

Nilüfer Aygün Bilecik 0000-0002-5113-2287

Publication Date April 30, 2023
Acceptance Date March 29, 2023
Published in Issue Year 2023 Volume: 6 Issue: 1

Cite

APA Aygün Bilecik, N. (2023). Neuropathic Pain in Spinal Cord Injuries. Journal of Cukurova Anesthesia and Surgical Sciences, 6(1), 140-146. https://doi.org/10.36516/jocass.1243810

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