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Posttraumatic Neuropathic Pain

Posttraumatic neuropathic pain is a condition that can occur after a spinal cord injury and can sometimes be referred to as central neuropathic pain, central deafferent pain or neurogenic pain. These are pains generated by the injured spinal cord itself. Following spinal cord injury, patients can experience pain in areas of the body where they do not have normal sensation. These pains can occur anywhere at or below the level of injury. Patients classically describe these pains as burning, stinging, stabbing, electrical, sharp, shooting and/or squeezing, tight, pressure, and vise-like. These pains may present at or very near the time of the injury or may occur later (one to many years after the time of injury). The first line of treatment for these kinds of pains is medication. Typically antidepressants or antiseizure medications are used to treat these pains. If medication is not successful, neurosurgical intervention may be an option.

Surgical Options for Neuropathic Pain

Spinal Cord Untethering: When pain starts more than a year after injury or is getting progressively worse over time, and medications are not helpful, spinal cord untethering surgery can be an option. See Posttraumatic Tethered Cord and Syringomyelia Section on this website.

Computer-Assisted Dorsal Root Entry Zone Microcoagulation: This surgery is performed on the paraplegic population for burning, sharp, electrical, stabbing, pins-and-needles, and "aching" pains which occur at or below the level of injury. It involves electrical recording inside the spinal cord at the time of surgery to identify regions of abnormally active pain-producing nerve cells. These abnormal nerve cells are then destroyed with radio frequency heat lesions. Because this surgery is partially destructive to the spinal cord, it is performed on spinal cord injured patients with minimal to no function below their level of injury.

References: Falci, S., Indeck C., et al. Posttraumatic Spinal Cord Tethering and Syringomyelia: Surgical Treatment and Long-Term Outcome. Journal of Neurosurgery, Spine. 2009; 11(4):445-460.

Falci, S., Best, L., et al. DREZ Mircocoagulation for Central Pain of Spinal Cord Injury: Operative Intramedullary Electrophysiologic Guidance and Clinical Outcome. Journal of Neurosurgery: Spine. 2002;97(2):193-200.