Neuropathic Pain Management in Spinal Cord Injury

Neuropathic pain following spinal cord injury represents a chronic and often debilitating condition arising from damage to central or peripheral nervous structures. It manifests as burning, shooting or electric-shock sensations either at the level of the lesion or in regions below the injury. Pathophysiological mechanisms include central sensitisation within dorsal horn neurons, maladaptive plasticity in ascending and descending pathways, inflammation and ectopic discharges from damaged nerve fibres. Management strategies encompass pharmacological agents—such as anticonvulsants, certain antidepressants and opioids—each offering partial relief but often limited by side-effects and tolerance. Non-pharmacological approaches have gained traction, including spinal cord stimulation, dorsal root entry zone interventions, exercise programmes tailored to individual capacity and cognitive behavioural therapies. Recent emphasis on biomarker discovery and quantitative sensory testing aims to stratify patients into mechanistic subgroups, guiding personalised care. Despite advances, effective long-term control remains elusive for many, underscoring the need for integrated models of care that combine novel neuromodulation techniques, multidisciplinary rehabilitation and adaptive self-management to improve quality of life on a global scale.

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Neuropathic Pain Management in Spinal Cord Injury publication trend

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Technical terms

Neuropathic pain: Pain resulting from a lesion or disease affecting the somatosensory nervous system.

Spinal cord injury: Damage to the spinal cord that impairs motor, sensory or autonomic function below the level of lesion.

Dorsal root entry zone (DREZ): The region where primary sensory nerve fibres enter the spinal cord’s dorsal horn.

Quantitative sensory testing (QST): A battery of psychophysical tests measuring sensory thresholds for temperature, touch and pain to characterise nerve function.

Functional magnetic resonance imaging (fMRI): A non-invasive imaging technique that detects changes in blood flow to infer neural activity and connectivity.

Central sensitisation: An increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold afferent input.

Hyperalgesia: An amplified pain response to a stimulus that typically causes pain.

Allodynia: Pain elicited by a stimulus that does not normally provoke pain, such as light touch.

References

1. Assessing the Feasibility of a Multimodal Approach to Pain Evaluation in Early Stages after Spinal Cord Injury. International Journal of Molecular Sciences (2023).
2. Neuropathic pain relief and altered brain networks after dorsal root entry zone microcoagulation in patients with spinal cord injury. Brain Communications (2024).
3. The CanPain SCI clinical practice guidelines for rehabilitation management of neuropathic pain after spinal cord injury: 2021 update. Spinal Cord (2022).