Posttraumatic neuropathic pain following spinal cord injury

Background: Severe posttraumatic neuropathic chronic pain in paralyzed limbs occurs in 10-30% of patients following spinal cord injury. Effective pain relief is a key prerequisite for successful rehabilitation in these individuals. Aim: To identify different patterns of posttraumatic neuropathic pain and determine which pain features are most responsive to surgical intervention. Materials and Methods: A consecutive series of 45 patients with gunshot-induced spinal cord injuries was analyzed for posttraumatic neuropathic pain, focusing on the nature and distribution of the pain. The standard McGill-Melzack Pain Questionnaire was used to assess pain characteristics, while pain distribution was recorded using body maps drawn by the patients. Two distinct pain qualities were identified: thermal (burning) and mechanical (cutting). Pain distribution was classified as either localized or diffuse. Dorsal Root Entry Zone (DREZ) lesion surgery was performed to achieve pain relief. Results: There were 21 patients (47%) suffering from pain of mechanical nature, 7 patients (15%) experiencing pain of pure thermal nature, and 17 patients (38%) with combined mechanical and thermal pain. There were 38 patients (85%) who reported localized pain, while 7 patients (15%) experienced diffuse pain. Pain relief was achieved in all patients with localized pain, regardless of whether the pain was thermal or mechanical. In contrast, DREZ surgery was ineffective in patients with diffuse pain. Conclusion: Localized posttraumatic neuropathic pain was the most common pattern observed in patients following spinal cord injury and showed the highest responsiveness to DREZ surgery. In contrast, diffuse pain demonstrated poor responsiveness to this surgical intervention.