Abstract
Study designClinimetric cross-sectional cohort study in adults with paraplegic spinal cord injury (SCI) and neuropathic pain (NP).ObjectiveTo assess the reliability of standardized quantitative pain drawings in patients with NP following SCI.SettingHospital-based research facility at the Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.MethodsTwenty individuals with chronic thoracic spinal cord injury and neuropathic pain were recruited from a national and local SCI registry. A thorough clinical examination and pain assessments were performed. Pain drawings were acquired at subsequent timepoints, 13 days (IQR 7.8–14.8) apart, in order to assess test-retest reliability.ResultsThe average extent [%] and intensity [NRS 0–10] of spontaneous NP were 11.3% (IQR 4.9–35.8) and 5 (IQR 3–7), respectively. Pain extent showed excellent inter-session reliability (intraclass correlation coefficient 0.96). Sensory loss quantified by light touch and pinprick sensation was associated with larger pain extent (rpinprick = −0.47, p = 0.04; rlight touch = −0.64, p < 0.01).ConclusionAssessing pain extent using quantitative pain drawings is readily feasible and reliable in human SCI. Relating information of sensory deficits to the presence of pain may provide distinct insights into the interaction of sensory deafferentation and the development of neuropathic pain after SCI.
Highlights
Information regarding the distribution of pain is contained in the International Spinal Cord Injury Pain Basic Data Set as eight principal areas [7] based on the classical body chart designed by Margolis [8]
While such a format of data collection may be most suitable for current databases, it does not allow for an unbiased quantification of pain extent, as the regions differ in size and are not delineated along precise anatomical landmarks
Pain extent derived from quantitative pain drawings may potentially inform our pathophysiological understanding of neuropathic pain (NP) after spinal cord injuries (SCI) by relating clinical measures of pain to central sensitization processes as previously shown for other pain conditions [9]
Summary
Information regarding the distribution of pain is contained in the International Spinal Cord Injury Pain Basic Data Set as eight principal areas [7] based on the classical body chart designed by Margolis [8]. While such a format of data collection may be most suitable for current databases, it does not allow for an unbiased quantification of pain extent, as the regions differ in size and are not delineated along precise anatomical landmarks. Pain extent derived from quantitative pain drawings may potentially inform our pathophysiological understanding of NP after SCI by relating clinical measures of pain (e.g., widespread pain) to central sensitization processes as previously shown for other pain conditions [9]
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