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KMID : 1037820140030010028
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Journal of Pain and Autonomic Disorders
2014 Volume.3 No. 1 p.28 ~ p.33
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Autonomic Dysfunctions and Pain in Patients with Spinal Cord Inj
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Kim Soo-Jin
Koh Seong-Eun
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Abstract
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Spinal cord injury (SCI) causes medical complications as well as neurological problems. Among the
complications, autonomic dysreflexia and pain are problems which need rapid and proper management. Autonomic dysreflexia is well known clinical emergency in patients with SCI, especially with injury at level T6 or above. An adverse stimulus originating below the level of SCI, most commonly irritation of the urinary bladder or colon, triggers a massive sympathetic discharge and results in acute increase of blood pressure which can lead hypertensive crisis. Management starts with lowering blood pressure and elimination of causes. Pharmacological agents should be initiated when systolic blood pressure remains elevated over 150mmHg. For prevention of autonomic dysreflexia, it is important to manage bladder and bowel properly and educate patients with SCI and their family. Pain in patients with SCI is common problem which decrease quality of life. Bryce-Ragnarsson introduced an SCI pain taxonomy based on pain locations (above level, at level, and below level), characters (nociceptive or neuropathic) and etiologic subtype. Patients with SCI often complain
pain above injury level caused by repetitive microtrauma and neuropathic pain below injury level. For patients with mild symptoms, management starts from explaining pain character and reassurance. Pharmacological intervention includes antidepressants, anticonvulsants, analgesics and opioids. For severe pain, surgical intervention can be considered.
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KEYWORD
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Spinal cord injury, Autonomic dysfunctions, Pain
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