Pain After Spinal Cord Injury

Abstract

Spinal Cord Injury Pain: Assessment, Mechanisms, Management Edited by Robert P. Yezierski and Kim J. Burchiel Published by the International Association for the Study of Pain, Seattle, Washington, USA, 2002 443 pages, $89.00 ($67.00 for members) (Hardcover) As noted in the preface of this excellent book, “this volume represents the proceedings of the 3rd IASP Research Symposium, entitled Spinal Cord Injury Pain: Clinical Characteristics and Experimental Studies, held April 16–19, 2001.” The text is divided into 5 parts with 26 chapters (written by 55 authors), covering clinical characteristics and assessment, experimental studies, imaging, treatment, and a one-chapter section discussing future directions for the study and treatment of spinal cord injury (SCI) pain, written by the editors. This volume has appeal to a broad audience since it is truly transdisciplinary, with offerings from clinicians and researchers in both the fields of pain management and spinal cord injury. As such, clinicians and researchers involved in SCI work will find this volume highly useful. SCI pain can be extremely difficult to manage and its effect on quality of life is profound. The meeting of minds in pain medicine and SCI care reflected in this text will no doubt serve as a springboard for future research collaboration. The book is well written and well edited, with minimal inconsistencies or contradictions among authors, and the chapters are logically laid out. The first section on clinical characteristics and assessment summarizes the literature to date, reviewing the various SCI pain classification systems, both etiological and descriptive. It then proceeds to describe a proposed unifying taxonomy, which characterizes SCI pain initially as nociceptive (musculoskeletal/visceral) or neuropathic (above, at, or below the level of injury), with specific structures and pathology outlined for each. If adopted, this alone would be worth the cost of the book, given the variety and confusing nature of terminologies used in the literature. The section on experimental studies has several interesting chapters reviewing possible mechanisms of central pain in current animal models. The last chapter in this section, by Craig, provides a useful review and synopsis of models of disinhibition, sensitization, and plasticity as mechanisms for SCI pain, and discusses the fascinating hypothesis that central pain is a thermoregulatory disorder. The section on imaging reviews both spinal cord and brain imaging (notably PET and fMRI), with insightful discussions of the changes evident in the brain, which appear to reflect the negative affective consequences of pain. The section on treatment, which is the most vexing aspect of SCI pain for the clinician, is perhaps the weakest part of this book, which reflects the lack of quality research, and the lack of consistent diagnostic nomenclature across studies. It does, however, lay a strong foundation for future collaborative work. The book ends on an optimistic note, with the final chapter suggesting directions for future research, in a new spirit of transdisciplinary cooperation. This text belongs on the bookshelf of any clinician or researcher who interacts in any way with spinal cord injured people. I suspect that in a decade or so, this volume may be considered a landmark in the field, in no small part because the antecedent symposium led to significant crossfertilization of research and treatment approaches to SCI pain.