Pain and spasticity after spinal cord injury: Mechanisms and treatment

Study Design: A comprehensive survey of literature on the proposed mechanisms and treatment of pain and spasticity after spinal cord injury (SCI) was completed. Objectives. To define the current understanding of these entities and to review various treatment options. Summary of Background Data. The neurophysiologic basis of spasticity after SCI is well established. The mechanism of neuropathic pain after SCI remains conjectural, although considerable new data, much of it from animal models, now add to our understanding of this condition. Methods. A comprehensive search and review of the published literature was undertaken. Results. Treatment options for spasticity are effective and include oral medication (baclofen, tizanidine), intrathecal baclofen, and rarely, surgical rhizotomy or myelotomy. Selected patients with post-SCI pain can respond to surgical myelotomy (DREZ lesions) or intrathecal agents (e.g., morphine + clonidine), but the majority continue to suffer. Conclusions. Medical and surgical treatments for spasticity are established and highly successful. Management of post-SCI pain remains a clinical challenge, as there is no uniformly successful medical or surgical treatment.