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SCI and Neuropathic Pain

Spinal cord injuries (SCI) are a result of severe damage to the spinal cord and lead to varying degrees of motor and sensory paralysis. Chronic pain is common after SCI and can occur in any part of the body, often persisting for prolonged periods and presenting significant barriers to performing everyday activities.

Neuropathic pain is usually chronic and is a result of distorted communication between the brain and the nerves damaged by a SCI which causes a change in the nerve function at the site of the injury and areas around it. It affects around half of all people with SCI and pain can occur immediately after SCI or develop and increase in intensity over time and can either be unrelenting or experienced at any time without any obvious event or cause, with the pain sensation often burning and sharp.

In addition to the symptoms of neuropathic pain, there are numerous side effects such as depression, anxiety, and issues sleeping which impact psychological and social functioning and contribute to a reduced quality of life. Combined with the physical impacts, these present major challenges to individuals and those involved in their care achieving positive rehabilitation outcomes.

Treatments for neuropathic pain

Neuropathic pain is one of the most challenging complications of SCI to treat, as each individual presents specific symptoms that make it difficult to isolate the origin of pain and prescribe a single course of treatment. Significant developments have been made in identifying common types of pain following SCI and their characteristics and in understanding the effectiveness of different types of treatment. A spinal cord injury case manager will formulate a rehabilitation plan that looks at a number of interventions in order to maximise outcomes and to avoid pain being a barrier to rehabilitation.

Physical treatments and interventions

  • Stretching and motion exercises or massages are effective therapies to strengthen muscles and reduce joint and muscle pain.
  • Neurostimulation techniques such as Acupuncture, Transcutaneous Electrical Nerve Stimulation (TENS) or Percutaneous Electrical Nerve Stimulation (PENS) are popular treatments that stimulate the body’s pain control mechanisms.

Psychological treatments and interventions

  • Relaxation and biofeedback techniques can help teach how to recognise the signs of stress and anxiety and engage mechanisms to self-manage muscle pain and mental tension.
  • Cognitive behavioural therapy (CBT) helps people learn how to think differently and react differently to pain by changes in brain activity impacting the experience of pain.
  • Psychotherapy to help set goals and identify positive associations in everyday life, or to help reduce anxiety connected with neuropathic pain.

Pharmacological treatments and interventions

  • Muscle relaxants and anti-spasticity medications including diazepam and baclofen are common medications for spasm-related and musculoskeletal pain and can be taken orally or delivered directly to the spinal cord using an intrathecal pump.
  • Non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen are common medications ingested to treat pain, as are opiates such as morphine, codeine, and oxycodone.

Surgical treatments and interventions

  • Dorsal column stimulators can be inserted into the spinal canal to treat pain caused by nerve root damage using high-frequency, low-intensity motions that stimulate the nerves.
  • Intrathecal pumps are sometimes surgically placed beneath the skin in the abdomen and administer morphine or baclofen directly to the spinal cord and nerve roots.
  • Nerve root injections and caudal epidurals can also provide temporary symptomatic relief.

Active research on neuropathic pain and SCI

Neuropathic pain has lasting effects on an individual’s quality of life, functional ability, and mental wellbeing. To date there is no cure and pain often does not respond to current interventions, so there is a need to explore alternatives that support its long-term treatment.

The team at Stoke Mandeville Spinal Research are funding a 3-year project led by St George's Hospital London and in collaboration with the London Spinal Cord Injury Centre Stanmore to identify the effectiveness of cingulotomy in pain treatment. This procedure is a type of neurosurgery that targets and inactivates specific brain pathways that regulate chronic pain, and it is hoped it can offer improved pain relief for patients with SCI.

Alex Alamri, a neurosurgery registrar at St Georges and one of the leads on the cingulotomy project highlights the positive impacts on neuropathic SCI pain available using cingulotomy.

“Despite the number of treatments available, those who suffer from chronic neuropathic pain continue to experience debilitating impacts to everyday life. Advances in technology have enabled cingulotomy to become minimally invasive with significantly reduced recovery times. Following the procedure, patients often report less preoccupation with pain, which results in less anxiety and stress and an improved quality of life. An additional impact is the reduced need for medication, which in turn reduces their side effects.” 

The principal objective of the research is to expand current understanding of the specific impacts of cingulotomy on patients with SCI and deliver evidentiary data in support of its use in treatment plans. In addition, it is hoped to gain greater knowledge on the connection between cingulotomy and improvements in mental health and wellbeing through enhancing the brains’ ability to respond to emotion and regulate motivation.

Following delays caused by the COVID pandemic, the project was initiated in early 2022 and will take the form of an open-label pilot study involving the monitoring of 12 patients selected using specific criteria. The study is expected to be completed in mid-2024, with findings published early the following year.

Further information on the research can be found at the Stoke Mandeville Spinal Research website.

Specialist services from Bush & Co

In partnership with the Spinal Injuries Association (SIA), Bush & Co offer clients access to the UK’s largest specialist SCI case management service. Offering an extensive network of health care professionals specialising in SCI, our case managers also access the SIA’s peer-led counselling resources which deliver specialist mental health support to people with SCI.

Our expert witness services assist with clinical negligence proceedings by providing medico-legal reports for both quantum and liability to claimant and defendant solicitors. We have a team of experienced clinical specialists with expertise in producing high-quality reports related to SCI.