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Korean J Spine 2004;1(3): 301-311.
11
Management of Pain Following Spinal Cord Injury
Jung Yul Park, M.D.
Department of Neurosurgery, College of Medicine, Korea University, Korea
Abstract
A great medical progresses over last three decades has given spinal cord injured individuals improved health and life style. However, chronic refractory pain has emerged for some as a significant challenge and the most difficult aspect with which they must cope. Spinal cord injury 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, both peripheral and central, and there are several groups of drugs that may synergistically act with these medications for better control of pain and thus for aiding in functional restoration. 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 treatments fail various surgical options are now available to provide substantial pain relief, if not all. These surgical therapeutic measurements belong 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 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 is needed. 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.
Keywords: Spinal cord injuryㆍNeuropathic pain, Pain managementㆍNeuroablationㆍNeurostimulationㆍNeuromodulation
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