neuropathic pain topic

8/9/2019 Neuropathic Pain topic

1/13

Neuropathic Pain on SCI

patients


2/13

What is Neuropathic pain?

• (“neurogenic pain”) is caused byabnormal communication betweenthe neres that were damaged byyour spinal cord in!ury and the brain"where nere signals that in#orm yourbrain how your body #eels are

interpreted$


3/13

%inds o# Neuropathic pain

• &t'leel neuropathic pain" sometimesdescribed as endone or borderone"which is a band o# burning" electric or

shooting pain and hypersensitiity in thedermatomes close to the leel o# in!ury

• *elow'leel neuropathic pain is located

di+usely below the leel o# in!ury usuallybilaterally in the buttoc,s and legs$

• &boe'leel neuropathic pain


4/13

• Neuropathic &boe'leel – Compressie mononeuropathies

– Comple- regional pain syndromes

• &t'leel – Nere root compression (including cauda

e.uina)

– Syringomyelia

– Spinal cord trauma/ischaemia

• *elow'leel – Spinal cord trauma/ischaemia


5/13

• the mechanisms underlyingneuropathic pain are poorlyunderstood$ *roadly" neuropathic

pain arises #rom abnormal actiity inpain pathways$


6/13

At-level and below-level neuropathic pains are morespecifcally related to spinal cord

injury and a number o possible mechanisms have beenproposed to account or these pain types.

• 0irect damage to the spinal cord

• 0amage to inhibitory mechanisms

•

Networ, changes with damage andloss o# inputs


7/13

Psychosocial 1echanisms

• pain catastrophiing (#ocusing uponnegatie aspects o# pain" such as #uturedisability)

• pain sel#'e2cacy (the indiidual3sperceied ability to manage despite thepain)"

• these mechanisms are signi4cant inin5uencing the leel o# psychologicaldistress and leel o# physical disabilityassociated with these pain conditions


8/13

Pain 1anagement

• 1anagement o# chronic pain syndromes #ollowing SCIproes ery di2cult and un#ortunately is o#ten onlypartially e+ectie$ &s already mentioned" whentreating chronic pain" it is essential to

comprehensiely ealuate the type/s o# pain andpsychosocial #actors contributing with emphasis on#unctional capabilities" behaioural responses to pain"ad!ustment to disability and degree o# motiation$

• 6ehabilitation principles should underpin any painmanagement programme" with the oerall ob!ectie

• being to increase sel#'e2cacy and promote greateractiity and participation$


9/13

Pharmacology

• &s described aboe" analgesics areusually insu2cient to controlneuropathic pain and should be used

in con!unction with ad!uantmedications$ 7or both chronic at'leeland below'leel types o# neuropathic

pain" 4rst'line treatment with eithergabapentin or pregabalin is nowrecommended$


10/13

Commonly prescribed medications#or neuropathic spinal cord in!ury pain

• Simple analgesics – Paracetamol

• 8ricyclic &ntidepressants – &mitriptyline ' &d!unctie medication #or

use in

– neuropathic pain$

• &nticonulsants – 9abapentin'6egarded as 4rst line

treatment o# neuropathic pain #ollowing

SCI$


11/13

• Pregabalin ' 7irst line treatment$6ecent 6C8 proided strongesteidence #or e2cacy in treatment o#

neuropathic SCI pain$

• Carbamaepine ' :+ectie intrigeminal neuralgia but controlled

studies in SCI pain are lac,ing$


12/13

;ther treatments

• Physiotherapy and occupational therapyinterentions may be necessary to improe4tness" posture and oeruse syndromes" in

particular• Signi4cant psychological co'morbidities (such

as psychiatric diagnosis" traumatic brain in!uryor drug and alcohol dependence) are li,ely to

inter#ere with the optimal management o#pain and there#ore re.uire separateassessment and management" and must beincluded in the treatment plan$


13/13

Strategies that health proessionals can suggest toclients that will contribute to reducing their pain-related disability and distress include:

< 1aintaining a regular pattern o# actiity despite the pain"rather than #alling into a =boom and bust3 cycle which dependson pain leels

< *rea,ing actiities into manageable chun,s and planningahead #or regular rest brea,s" rather than pushing on until

pain becomes unbearable< Planning ahead and prioritising actiities so that the personwith SCI can achiee the things that are most aluable tothem > not #orgetting to prioritise en!oyable actiities

< :stablishing a regular pattern o# medication use" rather than

only ta,ing it when pain leels become high< 0eeloping a plan #or dealing with days when the pain isworse" which can be shared with #amily and carers so thatthey can remind the person with SCI about what they wereplanning to do

< 8rying not to panic In contrast to acute pain conditions"most ersistent ain in the conte-t o# a s inal cord in ur is

neuropathic pain topic

Documents