Currently available interventions may require further refinement, however. “In response to neuroimaging studies demonstrating cortical remapping, treatments targeting plasticity have been explored. Most interventions have aimed at the motor system, [including] visual illusion, cognitive and virtual movement therapies and electrical stimulation of the motor cortex. This literature is also controversial and is complicated by the enormous variation in injury types of the people involved,” Dr. Wrigley noted.

Dr. Felix pointed out that the nature of neuropathic pain is likewise highly variable: “While the hallmark description of neuropathic pain is “burning” and/or “tingling” spontaneous pain, coupled with allodynic responses to tactile or thermal stimulation, there are a number of different symptom profiles and somatosensory phenotypes within the diagnosis of neuropathic pain that do not necessarily fit these criteria,” Dr. Felix said, concurring that research in the area of cortical reorganization may eventually lead to more effective treatment strategies for SCI patients.

“At present, many patients with chronic neuropathic pain do not find adequate pain relief with currently-available treatments. Clinicians should be encouraged to work with their patients with spinal cord injury to develop a personalized pain management plan that may include educating the patient on alternative, non-pharmacologic, treatment strategies,” Dr. Felix suggested.


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“Continued work by a number of researchers, approaching the problem of central neuropathic pain utilizing a variety of methods, will be necessary before we can arrive at a more comprehensive picture regarding the mechanisms responsible for the development and maintenance of this type of pain after neurologic injury. A better understanding of these mechanisms, through studies like that of [Dr. Jutzeler’s group] will eventually lead to better preventative strategies and treatment approaches,” Dr. Felix concluded.

References

1. Jutzeler CR, Freund P, Huber E, Curt A, Kramer JL. Neuropathic Pain and Functional Reorganization in the Primary Sensorimotor Cortex After Spinal Cord Injury. J Pain. 2015;16(12):1256-67. doi:10.1016/j.jpain.2015.08.008. Epub 2015 Sep 21.

2. Wrigley PJ, Press SR, Gustin SM, Macefield VG, Gandevia SC, Cousins MJ, Middleton JW, Henderson LA, Siddall PJ. Neuropathic pain and primary somatosensory cortex reorganization following spinal cord injury. Pain. 2009;141(1-2):52-59.