Variability in clinical and neurophysiological evaluation of pain development following acute spinal cord injury: a case report.

Abstract

Chronic neuropathic pain (NeP) often develops following traumatic spinal cord injury (SCI). This case report explores variability in clinical and neurophysiological aspects of pain evaluation in early post-trauma stages. A 34-year old female presenting with acute incomplete sensorimotor tetraplegia C4 AIS D was examined by neurological examination and pain assessment at three time points after acute trauma T1 (8 weeks), T2 (11 weeks), and T3 (24 weeks). Quantitative sensory testing (QST) and laser-evoked potentials (LEPs) were measured above (control area), at (area of NeP), and below (foot) the neurological level of injury (NLI). Musculo-skeletal and neuropathic pain were clinically present already during T1 but showed variations in localization and occurrence over time. Neuropathic pain classification varied between time points due to shifting of NLI. Above-level QST revealed minor, less pronounced abnormalities similar to at-level site. At-level QST (site of NeP) showed loss for thermal and mechanical detection thresholds but also gain of function for mechanical pain thresholds with a tendency of amelioration over time. QST below-level did not reveal remarkable changes over time. LEPs above- and below-level were within normal limits. At-level LEPs abolished after T1. In early stages post injury (up to 6 month) variations in pain presentation for both, musculo-skeletal and neuropathic pain as well as QST and LEP could be demonstrated. These findings suggest ongoing adaption mechanisms in sensory pathways, which require further exploration and may be relevant for prognostic and preventive strategies against the development of chronic neuropathic and nociceptive pain.