Neuropathic Pain Following Spinal Cord Injury: Mechanism, Assessment and Treatment

Spinal cord injury (SCI) is a devastating disease which may cause physical, psychological and social dysfunction. Neuropathic pain (NP) after SCI is common, can be seen in varying degrees and is one of the most difficultly treated problems developing after SCI. With the addition of the NP to loss of function after SCI, sleep patterns, moods and daily activities of patients are adversely affected. In order to treat pain effectively, classification of pain after SCI must be done carefully and correctly. According to classification of International Pain Study Group, pain after SCI is divided into two main groups as nociceptive and neuropathic pain. Neuropathic pain is defined as "pain occuring as a direct result of a disease or lesion directly affecting somato-sensorial system". NP after SCI can be classified according to anatomical region (above the level of lesion, at the level of lesion, below the level of lesion). Treatment of NP after SCI is often challenging and receiving response to treatment may take long time. Therefore, treatment of NP after SCI should be multifactorial. Treatment options include pharmochologic treatment, application of transcutanous electrical nerve stimulation, psychiatric treatment approaches, and surgical approaches in selected cases. In pharmachologic treatment, first line agents are tricyclic antidepresants, pregabalin and gabapentin. In this review, mechanisms and assessment and treatment of NP after SCI is discussed with the guide of current literature.