Neuropathic Pain Linked to Decreased Motor Cortical Plasticity After Spinal Cord Injury

Controversial Findings

In an interview with Clinical Pain Advisor, Paul Wrigley, PhD, from the Pain Management Research Institute at the University of Sydney, noted that the findings contrast with previous work, including a seminal article published by his own group.2

“The prevailing theory suggests that maladaptive brain changes occur in people that develop neuropathic pain following SCI,” Dr. Wrigley stated.

“The maladaptive plasticity theory is based in part on research demonstrating that the greater the neuropathic pain the larger the changes in brain activation remapping,” explained Elizabeth R. Felix, PhD, from the department of physical medicine and rehabilitation at the University of Miami’s Miller School of Medicine in Florida.

Though evidence of more extensive reorganization associated with the presence and severity of neuropathic pain may have been expected in persons with SCI, the results from study do not contradict its existence, Dr. Felix told Clinical Pain Advisor.

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“The complexity of the changes that may be occurring within the somatosensory and motor processing pathways might masked by the particular parameters of this study. Alternatively, as the authors propose, it may be that, rather than neuropathic pain being a result of cortical plasticity after spinal cord injury, neuropathic pain may be the cause of maintained neural activity which prevents excessive cortical reorganization in somatosensory and motor areas after a spinal cord injury,” Dr. Felix said.

Practical Implications

According to Dr. Wrigley, the findings of this study have practical implications for the management of patients with neuropathic pain.

“The consensus observation that neuropathic pain is linked with specific changes in brain function remains the key message. The linked proposal that brain plasticity can be influenced in a positive manner also remains important. These two ideas can be used to motivate people with neuropathic pain to engage in therapy as the details of the brain changes and how we can modify them are clarified over time,” Dr. Wrigley stated.