Neuropathic pain and SCI: Identification and treatment strategies in the 21st century

• Published in: Journal of the neurological sciences Vol. 384; pp. 75 - 83
• Main Authors: Hatch, Maya N., Cushing, Timothy R., Carlson, Gregory D., Chang, Eric Y.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.01.2018
• Subjects: ISCIP; Neuropathic pain; Neuropathic pain measures; Pain classification; Pain management; SCI pain treatment; Spinal cord injury; Pain classification; Pain management; SCI pain treatment; Neuropathic pain measures; ISCIP; Spinal cord injury; Neuropathic pain
• ISSN: 0022-510X; 1878-5883; 1878-5883
• DOI: 10.1016/j.jns.2017.11.018

Pain is a common complication in patients following spinal cord injury (SCI), with studies citing up to 80% of patients reporting some form of pain. Neuropathic pain (NP) makes up a substantial percentage of all pain symptoms in patients with SCI and is often complex. Given the high prevalence of NP in patients with SCI, proper identification and treatment is imperative. Indeed, identification of pain subtypes is a vital step toward determining appropriate treatment. A variety of pharmacological and non-pharmacological treatments can be undertaken including antiepileptics, tricyclic antidepressants, opioids, transcranial direct current stimulation, and invasive surgical procedures. Despite all the available treatment options and advances in the field of SCI medicine, providing adequate treatment of NP after SCI continues to be challenging. It is therefore extremely important for clinicians to have a strong foundation in the identification of SCI NP, as well as an understanding of appropriate treatment options. Here, we highlight the definitions and classification tools available for NP identification, and discuss current treatment options. We hope that this will not only provide a better understanding of NP for physicians in various subspecialties, but that it will also help guide future research on this subject. •This review includes discussion about current classifications and tools for identification of neuropathic pain in individuals with SCI.•Discussion of current pharmacological and non-pharmacological treatment for NP in SCI are provided.•Recommendations on what tools to use for NP identification in SCI patients, and a “decision tree” for NP treatment is included.•This is the first review to pair identification with treatment recommendations.