Chronic neuropathic pain in spinal cord injury patients: what relevant additional clinical exams should be performed?

OBJECTIVE

Study the indications and level of evidence of clinical exams that might be relevant in exploring the causes of neuropathic pain in spinal cord injury patients.

METHOD

Literature review from three databases: PubMed, Embase, Pascal.

RESULTS

Disparity and heterogeneity of the answers given by the attendees to the experts conference of the French Society of Physical Medicine and Rehabilitation (SOFMER) and the physicians surveyed via the SOFMER website. These results corroborate the shortage of available data on this topic in the literature. From this analysis, we can however validate spinal MRI imaging as a mandatory exam for the diagnosis of post-traumatic syringomyelia (cystic myelopathy) - this exam can even be considered a Gold Standard. Furthermore, we can also recommend using electrodiagnostic studies for compressive neuropathies. However, it is not possible to validate the relevance of additional clinical exams for radicular pain, segmental deafferentation pain, central deafferentation pain as well as Complex Regional Pain Syndrome (CRPS) type 1; for these types of pain we can only formulate experts recommendations in light of the dearth of available data on the subject.

CONCLUSION

For the neuropathic pain of spinal cord injury patients' additional clinical exams should be used in the framework of an etiological diagnosis.