Spinal Cord Injury Pain Research Articles

The Impact of Activity-Based Interventions on Neuropathic Pain in Experimental Spinal Cord Injury.

Physical activity-based rehabilitative interventions represent the main treatment concept for people suffering from spinal cord injury (SCI). The role such interventions play in the relief of neuropathic pain (NP) states is emerging, along with underlying mechanisms resulting in SCI-induced NP (SCI-NP). Animal models have been used to investigate the benefits of activity-based interventions (ABI), such as treadmill training, wheel running, walking, swimming, and bipedal standing. These activity-based paradigms have been shown to modulate inflammatory-related alterations as well as induce functional and structural changes in the spinal cord gray matter circuitry correlated with pain behaviors. Thus far, the research available provides an incomplete picture of the cellular and molecular pathways involved in this beneficial effect. Continued research is essential for understanding how such interventions benefit SCI patients suffering from NP and allow the development of individualized rehabilitative therapies. This article reviews preclinical studies on this specific topic, goes over mechanisms involved in SCI-NP in relation to ABI, and then discusses the effectiveness of different activity-based paradigms as they relate to different forms, intensity, initiation times, and duration of ABI. This article also summarizes the mechanisms of respective interventions to ameliorate NP after SCI and provides suggestions for future research directions.

Pain, pain interference, social and school/work functioning in youth with spinal cord injury: A mediation analysis

Context/Objective The objective of the present study was to investigate the effects of pain severity, pain interference and social functioning in a serial multiple mediator model predicting school/work functioning in youth with spinal cord injury (SCI) from their perspective. Design Explanatory or mechanistic study. Setting Pediatric specialty hospital. Participants 125 youth with SCI ages 8–24. Outcome Measures The Pain Severity Item and Pain Interference Scale from the PedsQL™ Spinal Cord Injury Module, and the Social Functioning and School/Work Functioning Scales from the PedsQL™ 4.0 Generic Core Scales Short Form SF15 were completed. Results Hierarchical multiple regression and serial multiple mediator model analyses were conducted to test the percent variability accounted for and the mediating effects of pain interference and social functioning in the association between pain severity and school/work functioning. Pain predictive effects on school/work functioning were serially mediated by pain interference and social functioning. In a predictive analytics model conducted with hierarchical multiple regression analysis, age, sex, pain, pain interference and social functioning accounted for 45% of the variance in youth-reported school/work functioning (P < 0.001), demonstrating a large effect size. Conclusion The mechanisms of the predictive effects of pain severity on school/work functioning in youth with SCI are explained in part by the serial multiple mediator effects of pain interference and social functioning. Identifying the multiple mediators of SCI pain on school/work functioning from the perspective of youth with SCI may facilitate future clinical research and practice to ameliorate impaired daily functioning and improve overall well-being.

Musculoskeletal pain in ambulatory patients with spinal cord injury who walking with or without walking devices: Prevalence and impact on walking speed

Background: Musculoskeletal pain in spinal cord injury (SCI) is a common problem. However, not much research exists on the prevalence of pain in ambulatory patients with SCI walking either with or without ambulatory assistive devices (AAD). Objectives: This study aimed to explore the prevalence of musculoskeletal pain and to investigate the impact of pain on walking speed in ambulatory patients with SCI walking with or without AAD. Materials and methods: There were 86 patients with SCI who were able to walk independently with or without AAD. All the patients were evaluated for musculoskeletal pain using a visual analogue scale (VAS). Then their walking speed was assessed using a 10-meter walk test (10MWT). Results: The proportion of patients with pain was high in both groups (63% in patients using AAD and 55% in patients not using AAD). For those with AAD, the fastest walking speed was significantly different in patients with mild, moderate, and severe pain compared to patients with no pain while for those without AAD, the fastest speed was significantly different in patients with moderate and severe pain compared to patients with no pain (p&lt;0.05). Conclusion: Musculoskeletal pain was commonly found in ambulatory patients with SCI walking with or without AAD, and this pain impacted their walking speeds. The finding of musculoskeletal pain in both patients walking with or without AAD could raise healthcare professionals’ awareness of the debilitating impact of musculoskeletal pain. Thus, the development of improved therapeutic approaches for reducing this impact is needed.

Pharmacological and non-pharmacological therapeutic interventions for the treatment of spinal cord injury-induced pain.

Spinal cord injury (SCI) is a complex neurophysiological disorder, which can result in many long-term complications including changes in mobility, bowel and bladder function, cardiovascular function, and metabolism. In addition, most individuals with SCI experience some form of chronic pain, with one-third of these individuals rating their pain as severe and unrelenting. SCI-induced chronic pain is considered to be “high impact” and broadly affects a number of outcome measures, including daily activity, physical and cognitive function, mood, sleep, and overall quality of life. The majority of SCI pain patients suffer from pain that emanates from regions located below the level of injury. This pain is often rated as the most severe and the underlying mechanisms involve injury-induced plasticity along the entire neuraxis and within the peripheral nervous system. Unfortunately, current therapies for SCI-induced chronic pain lack universal efficacy. Pharmacological treatments, such as opioids, anticonvulsants, and antidepressants, have been shown to have limited success in promoting pain relief. In addition, these treatments are accompanied by many adverse events and safety issues that compound existing functional deficits in the spinally injured, such as gastrointestinal motility and respiration. Non-pharmacological treatments are safer alternatives that can be specifically tailored to the individual and used in tandem with pharmacological therapies if needed. This review describes existing non-pharmacological therapies that have been used to treat SCI-induced pain in both preclinical models and clinical populations. These include physical (i.e., exercise, acupuncture, and hyper- or hypothermia treatments), psychological (i.e., meditation and cognitive behavioral therapy), and dietary interventions (i.e., ketogenic and anti-inflammatory diet). Findings on the effectiveness of these interventions in reducing SCI-induced pain and improving quality of life are discussed. Overall, although studies suggest non-pharmacological treatments could be beneficial in reducing SCI-induced chronic pain, further research is needed. Additionally, because chronic pain, including SCI pain, is complex and has both emotional and physiological components, treatment should be multidisciplinary in nature and ideally tailored specifically to the patient.

Effective Connectivity in Spinal Cord Injury-Induced Neuropathic Pain.

Aim: The aim of this study was to differentiate the effects of spinal cord injury (SCI) and central neuropathic pain (CNP) on effective connectivity during motor imagery of legs, where CNP is typically experienced. Methods: Multichannel EEG was recorded during motor imagery of the legs in 3 groups of people: able-bodied (N = 10), SCI with existing CNP (N = 10), and SCI with no CNP (N = 20). The last group was followed up for 6 months to check for the onset of CNP. Source reconstruction was performed to obtain cortical activity in 17 areas spanning sensorimotor regions and pain matrix. Effective connectivity was calculated using the directed transfer function in 4 frequency bands and compared between groups. Results: A total of 50% of the SCI group with no CNP developed CNP later. Statistically significant differences in effective connectivity were found between all groups. The differences between groups were not dependent on the frequency band. Outflows from the supplementary motor area were greater for the able-bodied group while the outflows from the secondary somatosensory cortex were greater for the SCI groups. The group with existing CNP showed the least differences from the able-bodied group, appearing to reverse the effects of SCI. The connectivities involving the pain matrix were different between able-bodied and SCI groups irrespective of CNP status, indicating their involvement in motor networks generally. Significance: The study findings might help guide therapeutic interventions targeted at the brain for CNP alleviation as well as motor recovery post SCI.

Biological and neurological activities of astaxanthin (Review).

Astaxanthin is a lipid-soluble carotenoid produced by various microorganisms and marine animals, including bacteria, yeast, fungi, microalgae, shrimps and lobsters. Astaxanthin has antioxidant, anti-inflammatory and anti-apoptotic properties. These characteristics suggest that astaxanthin has health benefits and protects against various diseases. Owing to its ability to cross the blood-brain barrier, astaxanthin has received attention for its protective effects against neurological disorders, including Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, cerebral ischemia/reperfusion, subarachnoid hemorrhage, traumatic brain injury, spinal cord injury, cognitive impairment and neuropathic pain. Previous studies on the neurological effects of astaxanthin are mostly based on animal models and cellular experiments. Thus, the biological effects of astaxanthin on humans and its underlying mechanisms are still not fully understood. The present review summarizes the neuroprotective effects of astaxanthin, explores its mechanisms of action and draws attention to its potential clinical implications as a therapeutic agent.

Prevalence and Determinants of Pain in Spinal Cord Injury During Initial Inpatient Rehabilitation: Data From the Dutch Spinal Cord Injury Database

ObjectiveTo describe the prevalence and characteristics of spinal cord injury (SCI)-related pain during initial inpatient rehabilitation and to investigate relationships with demographic and lesion characteristics. DesignCohort during inpatient rehabilitation. SettingEight specialized SCI rehabilitation centers in the Netherlands. ParticipantsPatients with newly acquired SCI admitted for inpatient rehabilitation between November 2013 and August 2019 (N=1432). InterventionsNot applicable. Main Outcome MeasuresPresence of pain at admission and discharge. Logistic regression analyses were used to study the prevalence of pain related to sex, age, etiology, completeness, and level of injury. ResultsData from 1432 patients were available. Of these patients 64.6% were male, mean age was 56.8 years, 59.9% had a nontraumatic SCI, 63.9% were classified as American Spinal Cord Injury Association Impairment Scale (AIS) D and 56.5% had paraplegia. Prevalence of pain was 61.2% at admission (40.6% nociceptive pain [NocP], 30.2% neuropathic pain [NeuP], 5.4% other pain) and 51.5% at discharge (26.0% NocP, 31.4% NeuP, 5.7% other pain). Having NocP at admission was associated with traumatic SCI. AIS B had a lower risk of NocP than AIS D at admission. Having NocP at discharge was associated with female sex and traumatic SCI. AIS C had a lower risk of NocP at discharge than AIS D. Having NeuP at admission was associated with female sex. Having NeuP at discharge was associated with female sex, age younger than 65 years vs age older than 75 years and tetraplegia. ConclusionsSCI-related pain is highly prevalent during inpatient rehabilitation. Prevalence of NocP decreased during inpatient rehabilitation, and prevalence of NeuP stayed the same. Different patient and lesion characteristics were related to the presence of SCI-related pain. Healthcare professionals should be aware of these differences in screening patients on presence and development of pain during inpatient rehabilitation.

Determining the management of pain in people with spinal cord injury by physiotherapists in South Africa

BackgroundPain after spinal cord injury (SCI) is common, and physiotherapy plays a pivotal role in alleviating pain for people with SCI.ObjectiveTo determine the modalities that physiotherapists in South Africa use to treat SCI-related pain and the factors that guide the selection of treatment modalities.MethodA quantitative, cross-sectional design using a self-developed online survey was distributed to physiotherapists belonging to the South African Society of Physiotherapy and the Physiotherapy Association of South Africa. Data were analysed using SPSS v26, where descriptive data were analysed using frequency, percentages, means and standard deviations, and Fisher’s exact tests for inferential analyses. Open-ended questions underwent thematic analysis.ResultsForty-six responses were received. The most-used modalities were transcutaneous electrical nerve stimulation (29.8%), exercises (27.7%) and joint mobilisations (29.8%). Most physiotherapists used standardised measurements to objectively assess pain characteristics, with the visual analog scale being the most used (70.2%). Except for the cost of treatment, the factors that guided the selection of the modalities included the pain type, onset, duration, location and intensity, pain interference, duration of treatment, patient’s preferences, other treatments that the patient was receiving for pain and psychosocial factors (87.2%).ConclusionsLocal physiotherapists use pain management modalities that are supported by the evidence to treat SCI-related pain.Clinical implicationsThis study highlights the common modalities used by physiotherapists to treat SCI-related pain, as well as the selection criteria for the modalities. Owing to the low response rate, we caution against generalising these findings across the SCI pain management field.

Comprehensive phenotyping of cutaneous afferents reveals early-onset alterations in nociceptor response properties, release of CGRP, and hindpaw edema following spinal cord injury

Spinal cord injury (SCI) is a complex syndrome that has profound effects on patient well-being, including the development of medically-resistant chronic pain. The mechanisms underlying SCI pain have been the subject of thorough investigation but remain poorly understood. While the majority of the research has focused on changes occurring within and surrounding the site of injury in the spinal cord, there is now a consensus that alterations within the peripheral nervous system, namely sensitization of nociceptors, contribute to the development and maintenance of chronic SCI pain. Using an ex vivo skin/nerve/DRG/spinal cord preparation to characterize afferent response properties following SCI, we found that SCI increased mechanical and thermal responding, as well as the incidence of spontaneous activity (SA) and afterdischarge (AD), in below-level C-fiber nociceptors 24 hr following injury relative to naïve controls. Interestingly, the distribution of nociceptors that exhibit SA and AD are not identical, and the development of SA was observed more frequently in nociceptors with low heat thresholds, while AD was found more frequently in nociceptors with high heat thresholds. We also found that SCI resulted in hindpaw edema and elevated cutaneous calcitonin gene-related peptide (CGRP) concentration that were not observed in naïve mice. These results suggest that SCI causes a rapidly developing nociceptor sensitization and peripheral inflammation that may contribute to the early emergence and persistence of chronic SCI pain.

Future Treatment of Neuropathic Pain in Spinal Cord Injury: The Challenges of Nanomedicine, Supplements or Opportunities?

Neuropathic pain (NP) is a common chronic condition that severely affects patients with spinal cord injuries (SCI). It impairs the overall quality of life and is considered difficult to treat. Currently, clinical management of NP is often limited to drug therapy, primarily with opioid analgesics that have limited therapeutic efficacy. The persistence and intractability of NP following SCI and the potential health risks associated with opioids necessitate improved treatment approaches. Nanomedicine has gained increasing attention in recent years for its potential to improve therapeutic efficacy while minimizing toxicity by providing sensitive and targeted treatments that overcome the limitations of conventional pain medications. The current perspective begins with a brief discussion of the pathophysiological mechanisms underlying NP and the current pain treatment for SCI. We discuss the most frequently used nanomaterials in pain diagnosis and treatment as well as recent and ongoing efforts to effectively treat pain by proactively mediating pain signals following SCI. Although nanomedicine is a rapidly growing field, its application to NP in SCI is still limited. Therefore, additional work is required to improve the current treatment of NP following SCI.

Cross-cultural adaptation and validation of the French version of the Spinal Cord Injury Pain Instrument (SCIPI).

Cross-sectional. To assess the reliability and validity of the French version of the Spinal Cord Injury Pain Instrument (SCIPI) and to determine its performance versus "Douleur Neuropathique 4 questions" (DN4) in diagnosing neuropathic pain (NeuP). Clinique romande de réadaptation, spinal cord injury (SCI) center in the French-speaking part of Switzerland. Backward and forward translation in French of the 4-itemSCIPI were performed by native speakers in both languages. Thirty persons with SCI were included in the validation study. Internal consistency was measured with the Kuder-Richardson (KR-20) coefficient. Cohen's kappa coefficients were used to assess the test-retest reliability and the agreement between SCIPI and DN4. Clinical assessment was used as the reference standard to diagnose NeuP. The area under the receiver operator characteristics curve (AUROC) was used to assess the performance of diagnostic tests. KR-20 coefficient of internal consistency was 0.50 (95% CI 0.26, 0.74). Test-retest reliability coefficient was 0.86 (95% CI 0.76, 0.95). The best cutoff value was 2 points, resulting a sensitivity of 88% (95% CI 69%, 98%) and a specificity of 92% (95% CI 75%, 99%). SCIPI had an AUROC of 0.90 (95% CI 0.82, 0.98), which was not significantly lower than the AUROC for DN4, 0.92 (95% CI 0.85, 0.99, p = 0.56). Agreement between SCIPI and DN4 was of 0.88 (95% CI 0.77, 1.00). The French version of the SCIPI is a reliable and valid tool that can identify the presence of NeuP in an individual with SCI.

Macrophage Migration Inhibitory Factor (MIF) Makes Complex Contributions to Pain-Related Hyperactivity of Nociceptors after Spinal Cord Injury.

Neuropathic pain is a major, inadequately treated challenge for people with spinal cord injury (SCI). While SCI pain mechanisms are often assumed to be in the CNS, rodent studies have revealed mechanistic contributions from primary nociceptors. These neurons become chronically hyperexcitable after SCI, generating ongoing electrical activity that promotes ongoing pain. A major question is whether extrinsic chemical signals help to drive ongoing electrical activity after SCI. People living with SCI exhibit acute and chronic elevation of circulating levels of macrophage migration inhibitory factor (MIF), a cytokine implicated in preclinical pain models. Probable nociceptors isolated from male rats and exposed to an MIF concentration reported in human plasma (1 ng/ml) showed hyperactivity similar to that induced by SCI, although, surprisingly, a 10-fold higher concentration failed to increase excitability. Conditioned behavioral aversion to a chamber associated with peripheral MIF injection suggested that MIF stimulates affective pain. A MIF inhibitor, Iso-1, reversed SCI-induced hyperexcitability. Unlike chronic SCI-induced hyperexcitability, acute MIF-induced hyperexcitability was only partially abrogated by inhibiting ERK signaling. Unexpectedly, MIF concentrations that induced hyperactivity in nociceptors from naive animals, after SCI induced a long-lasting conversion from a highly excitable nonaccommodating type to a rapidly accommodating, hypoexcitable type, possibly as a homeostatic response to prolonged depolarization. Treatment with conditioned medium from cultures of DRG cells obtained after SCI was sufficient to induce MIF-dependent hyperactivity in neurons from naive rats. Thus, changes in systemic and DRG levels of MIF may help to maintain SCI-induced nociceptor hyperactivity that persistently promotes pain.SIGNIFICANCE STATEMENT Chronic neuropathic pain is a major challenge for people with spinal cord injury (SCI). Pain can drastically impair quality of life, and produces substantial economic and social burdens. Available treatments, including opioids, remain inadequate. This study shows that the cytokine macrophage migration inhibitory factor (MIF) can induce pain-like behavior and plays an important role in driving persistent ongoing electrical activity in injury-detecting sensory neurons (nociceptors) in a rat SCI model. The results indicate that SCI produces an increase in MIF release within sensory ganglia. Low MIF levels potently excite nociceptors, but higher levels trigger a long-lasting hypoexcitable state. These findings suggest that therapeutic targeting of MIF in neuropathic pain states may reduce pain and sensory dysfunction by curbing nociceptor hyperactivity.

Exploring the Social Determinants of Health Outcomes for Adults with Low Back Pain or Spinal Cord Injury and Persistent Pain: A Mixed Methods Study

Developing a greater understanding of the social and environmental factors that are related to differential outcomes for individuals who experience persistent pain and disability is important for achieving health equity. In this study, we aimed to develop insights into the role of the social determinants of health (SDH) in care experiences and health status for socio-economically disadvantaged adults who experience persistent low back pain or persistent pain following spinal cord injury. Our objectives were to investigate 1) relationships between the SDH and health outcomes, 2) care experiences, and 3) perceived barriers and facilitators to optimal pain care. We conducted a mixed-methods convergent parallel study involving an online survey and semistructured interviews. We analyzed the data from each method separately and integrated the findings. One hundred sixty-four adults completed the survey and 17 adults completed the semistructured interviews. We found large or moderate-sized correlations between greater selfreported social isolation and poorer health outcomes. Experiencing a higher number of adverse SDH was moderately correlated with lower quality of life and was significantly correlated with all other outcomes. We generated 5 themes from the qualitative analysis: active strategies are important for well-being; low agency; facilitators of optimal care; barriers to optimal care; and health inequities, and derived meta-inferences that highlight the complex inter-relationships between the SDH and health outcomes in this cohort. The findings of our study can importantly inform endeavors to improve equity of pain care for adults with low back pain or spinal cord injury and persistent pain. PerspectiveThis study illustrates the complex interplay between adverse social determinants of health and poorer health status for adults with persistent pain and provides evidence to support the important role of social isolation. Developing an understanding of the life-contexts of those seeking care is a vital step towards addressing health inequities.

Translation, cross-cultural adaptation, and analysis of the measurement properties of the Brazilian Portuguese version of the spinal cord injury pain instrument.

Study designA questionnaire validity study.ObjectivesTo perform the translation, cross-cultural adaptation, and analysis of the measurement properties of the Brazilian Portuguese version of the Spinal Cord Injury Pain Instrument (SCIPI) for the screening of neuropathic pain in spinal cord injury.SettingNeurorehabilitation hospital in north-eastern Brazil.MethodsWe performed the translation and cross-cultural adaptation of the SCIPI. The pre-final version was applied in 10 patients with spinal cord injury sequelae and pain report. The final version of the SCIPI was applied to 100 patients. The measurement properties evaluated were structural validity, test-retest reliability, internal consistency, construct validity, and diagnostic accuracy.ResultsNone of the items in the pre-final version of the SCIPI had any comprehension problems. The one-dimensional structure of the final version of the SCIPI was adequate. There were significant correlations between the SCIPI and the Douleur Neuropathique 4 (rho = 0.546), as well as adequate test-retest reliability (intraclass correlation coefficient = 0.89, kappa ≥ 0.79), internal consistency (Cronbach’s alpha ≥ 0.76), and diagnostic accuracy (area under the curve = 0.860).ConclusionThe Brazilian version of the SCIPI presents measurement properties that are suitable for measuring neuropathic pain related to spinal cord injury.

Proof of Concept of Using Cognitive Multisensory Rehabilitation for Neuropathic Pain Relief in Adults with Spinal Cord Injury

<h3>Research Objectives</h3> About 53% (ranging from 34% to 74%) of Americans with a spinal cord injury (SCI) have neuropathic pain.1-2 Our prior research identified brain areas responsible for body awareness, which are also involved in pain perception. Since adults with SCI have impaired body awareness,3-4 then improving body awareness may lead to neuropathic pain relief. Therefore, we evaluated the proof of concept of whether Cognitive Multisensory Rehabilitation (CMR)5-7 a physical therapy treatment that helps restore body awareness reduces neuropathic pain in adults with SCI and neuropathic pain. <h3>Design</h3> Single group, pre-post design with follow-up phase. <h3>Setting</h3> Brain Body Mind Lab, University of Minnesota. <h3>Participants</h3> We recruited 8 adults (three women) with SCI, paraplegia and neuropathic pain, and average age 51.88 ±16.13 years. They were 2-56 years after SCI, with injury levels ranging from C4 to L2, ASIA A to D. We used fliers, recruitment letters, and posted the study on ClinicalTrials.gov for recruitment. <h3>Intervention</h3> CMR helps participants be more aware of where their body is in space. Sensory function is trained with sensory discrimination tasks. A physical therapist specialized in CMR treated the participants for 45min/session, 3 times/week for 6 weeks. <h3>Main Outcome Measures</h3> We monitored pain intensity levels on the Numeric Pain Rating Scale for highest, average, and lowest pain in the prior week. We reported effect sizes at baseline, post-CMR, and after a 6-week follow-up period. <h3>Results</h3> Large effect sizes were found for all pain intensity levels between baseline and post-CMR and between baseline and the 6-weeks follow-up. The average change score for those 2 time periods were: lowest pain: 1.38±0.74 (effect size Cohen's d=0.82) and 1.63±1.169 (d=1.04); average pain 2.38±2.00 (d=1.25); and 2.63±2.00 (d=1.65); highest pain 2.25±1.98 (d=0.99), and 2.50±2.45 (d=1.32), respectively. <h3>Conclusion</h3> We confirmed the proof of concept that CMR reduces neuropathic pain in adults with SCI. The pain reduction was maintained during the 6-weeks follow-up. Further validation in a larger sample size is needed. <h3>Author(s) Disclosures</h3> No conflict of interest.

Effects of repeated transcranial magnetic stimulation in the dorsolateral prefrontal cortex versus motor cortex in patients with neuropathic pain after spinal cord injury: a study protocol

IntroductionNeuropathic pain is one of the common complications of spinal cord injuries (SCI), which will slow down the recovery process and result in lower quality of life. Previous studies have...

Neuropathic Pain in Neurologic Disorders: A Narrative Review.

Neuropathic pain is defined as a painful condition caused by neurological lesions or diseases. Sometimes, neurological disorders may also be associated with neuropathic pain, which can be challenging to manage. For example, multiple sclerosis (MS) may cause chronic centralized painful symptoms due to nerve damage. Other chronic neuropathic pain syndromes may occur in the form of post-stroke pain, spinal cord injury pain, and other central pain syndromes. Chronic neuropathic pain is associated with dysfunction, disability, depression, disturbed sleep, and reduced quality of life. Early diagnosis may help improve outcomes, and pain control can be an important factor in restoring function. There are more than 100 different types of peripheral neuropathy and those involving sensory neurons can provoke painful symptoms. Accurate diagnosis of peripheral neuropathy is essential for pain control. Further examples are represented by gluten neuropathy, which is an extraintestinal manifestation of gluten sensitivity and presents as a form of peripheral neuropathy; in these unusual cases, neuropathy may be managed with diet. Neuropathic pain has been linked to CoronaVirus Disease (COVID) infection both during acute infection and as a post-viral syndrome known as long COVID. In this last case, neuropathic pain relates to the host’s response to the virus. However, neuropathic pain may occur after any critical illness and has been observed as part of a syndrome following intensive care unit hospitalization.

Pain and pain management experiences following spinal cord injury – a mixed methods study of Australian community-dwelling adults

Purpose There is a high prevalence of persistent pain following SCI yet insights into its impact and the quality of pain care are limited. We aimed to explore, in-depth, the problem of persistent pain in Australian community-dwelling adults with a spinal cord injury (SCI). Our objectives were to investigate (i) how individuals experience persistent pain, (ii) how they experience pain care and (iii) the concordance between clinical practice guidelines for managing pain and reported care practices. Methods We conducted a mixed-methods convergent parallel study. Adults with SCI and persistent pain completed a survey (n = 43); a subset of participants completed interviews (n = 10). We analysed the data from each method separately and then integrated the findings. Results Results indicated that the life impact of persistent pain is variable but it can be more disabling than physical impairments and compound a sense of isolation and despair. Community-based management was reported to predominantly have a pharmacological focus, with occurrences of opioid misuse apparent in the data. Access to expert, comprehensive and individualised care was frequently reported as inadequate. Conclusion While some people with SCI and persistent pain can effectively self-manage their pain, for others the impact on quality of life is profound and complex care needs are commonly unmet. IMPLICATIONS FOR REHABILITATION Persistent pain is a common consequence of SCI and profoundly impacts quality of life. Complex pain care needs are commonly unmet. Individuals require regular, comprehensive, biopsychosocial assessment. The effectiveness of pain management strategies must be monitored on an ongoing basis. Opportunities for personal self-management support must be available long-term.

The demographics of pain after spinal cord injury: a survey of our model system.

Survey OBJECTIVES: Better understand the demographics of pain after spinal cord injury (SCI). Academic Level 1 trauma center and SCI Model System. A survey including general demographic questions, questions of specific interest to the authors, the standardized SCI Pain Instrument (SCIPI), International SCI Pain Data Set, Basic form (ISCIPDS:B), Patient Reported Outcomes Measurement Information System (PROMIS) neuropathic 5a (PROMIS-Neur), and PROMIS nociceptive 5a (PROMIS-No). 81% of individuals with SCI experience chronic pain and 86% of individuals with pain have neuropathic pain. 55% of individuals had shoulder pain. Females and those who recall >5/10 pain during initial hospital stay had significantly higher PROMIS-Neur scores. Completeness of injury correlates inversely with the degree of neuropathic pain. Those who recall >5 pain during the initial hospital stay and those who reported the worst or second worst pain as being shoulder pain had significantly higher PROMIS-No scores. Lumbosacral injuries trended towards higher PROMIS-No scores and had the highest PROMIS-Neur scores. Those with tetraplegia were more likely to develop shoulder pain and those with shoulder pain had higher PROMIS-No scores. Chronic pain is almost universal in patients with SCI. Pain is more commonly reported as neuropathic in nature and females reported more neuropathic pain than males. Physicians should monitor for nociceptive shoulder pain, particularly in those with tetraplegia. Patients with incomplete injuries or lumbosacral injuries are more likely to report higher levels of neuropathic pain and pain levels should be monitored closely. Those with more neuropathic and nociceptive pain recall worse pain at initial hospitalization. Better understanding pain demographics in this population help screen, prevent and manage chronic pain in these patients.

A Simple and Cost-effective Weight Drop Model to Induce Contusive Spinal Cord Injury: Functional and Histological Outcomes

Background: Animal spinal cord injury (SCI) models have provided a better perception of the mechanisms related to traumatic SCI and evaluation of the effectiveness of experimental therapeutic interventions. Objectives: The aim of this study is to develop a cost-effective modified Allen's device to induce contusive spinal cord injury. Methods: Adult male Wistar rats were subjected to contusive spinal cord injury using a customized weight drop model through 10-g weights delivered from a 25-mm height onto an exposed spinal cord. Locomotor and sensory function during 28 days were assessed. Moreover, histopathological changes were assessed at one week and 28 days post SCI. Results: All the SCI rats showed hind limb paralysis up to 48 h post SCI and neuropathic pain after injury. Histological changes similar to the previous reports for contusion model were observed. Conclusions: According to our findings, little variability was observed in the BBB score of individual rats at 28 days after injury. Our customized device to induce spinal cord injury is a simple and inexpensive alternative method to the highly sophisticated contusion device commonly used to induce SCI.