Chronic pain at the spinal cord injured patients

Chronic pain is an important problem following spinal cord injury (SCI) and is a mayor impediment to effective rehabilitation. The purpose of this study is to define chronic neuropathic pain and to evaluate its characteristics in SCI patients. Fortyone spinal cord injured patients presenting with chronic pain were enrolled in the study. Three patients were tetraplegic, 38 patients were paraplegic. The localization of pain was at level of lesions in 12 patients, below level of lesions in 26 patients and both at level and below level of lesions in 3 patients. Paralysis were central type in 23 patients and peripheral type in 13 patients. SCI was complete in 26, incomplete in 15. Pain had begun at the first month of injury in 34% and 1-3 months in 53.6% of the patients. Pain was spreading out diffusely at deafferent regions in 16 patients and was dermatomal in 17 patients. In patients with central type of paralysis, pain was spreading out diffusely in 52.2% patients, while it was dermatomal in 92.4% patients with peripheral type of paralysis. In complete SCI patients, pain was spreading out diffusely at deafferented regions in 50% and was in burning character in 53%. In incomplete SCI patients, pain was dermatomal in 80%, and in tinoling character in 60%. The incidence of dermatomal distributed pain was significantly higher in incomplete and peripheral lesions. The incidence of diffusely distributed and burning pain was significantly higher in complete and central lesions. In conclusion, chronic pain with SCI was seen in the first 3 months following injury. It has been suggested that dermatomal distribution is more common at deafferented regions in peripheral type and incomplete lesions, but diffuse distribution is seen in complete lesions.