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KMID : 0614520090190010016
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Journal of the Korean Pain Research Society
2009 Volume.19 No. 1 p.16 ~ p.16
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Management of Pain Following Spinal Cord Injury
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Park Jung-Yul
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Abstract
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A great medical progress in recent years has provided spinal cord injured patients much improved quality of life. However, chronic refractory pain associated with spinal cord injury(SCI) has emerged for some as a significant challenge and the most difficult aspect with which they must cope. SCI pain, especially the chronic persistent type, is usually central neuropathic pain that mainly requires centrally-directed treatment. Many newer medications are now being available for this type of pain, and there are several categories of drugs that may synergistically act with these medications for better control of pain and thus for aiding in functional capacity. Moreover, there are also drugs that belong to other classifications but adjunctively act for different types of symptoms(i.e., muscle spasm, rigidity, sleep disturbances, etc.). When these conservative treatment fails various surgical options are now available to provide substantial pain relief, if not all. These surgical therapeutic measurements belongs either to neuroablations (e.g., dorsal root entry zone (DREZ) operation, radiofrequency dorsal root ganglion lesioning) or neuromodulaton(e.g., spinal cord stimulation, motor cortex stimulation, and drug pump). Since these pains are usually neuropathic in nature neuromodulative therapy should be considered initially. However, the neuroablative treatment option is still cost-effective and safe thus may be considered in certain selected cases. The intention of this review is to summarize the treatment options currently available that begin with conservative medical and physical therapy progresses to neurosurgical procedures. Usually, no single treatment is efficacious and instead an eclectic program will be necessary. Multiple treatments require a team of multi-disciplined professionals to provide the appropriate combination of ongoing care that can reduce the pain and suffering of chronic spinal cord injury pain.
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KEYWORD
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Spinal cord injury, Neuropathic pain, Pain management, Neuroablation, Neurostimulation, Neuromodulation
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