Metabolites of neuroinflammation relate to neuropathic pain after spinal cord injury

Neurology, 2020 · DOI: 10.1212/WNL.0000000000010003 · Published: August 18, 2020

Spinal Cord Injury Neurology Pain Management

Simple Explanation

This study investigates the relationship between metabolites in the spinal cord and neuropathic pain (NP) after a spinal cord injury (SCI). It uses magnetic resonance spectroscopy (MRS) to measure levels of certain metabolites in patients with and without NP. The researchers focused on metabolites related to neuroinflammation and neurodegeneration, specifically looking at the ratios of choline-containing compounds to myo-inositol (tCho/mI) and total N-acetylaspartate to myo-inositol (tNAA/mI). The study found that patients with NP had elevated levels of tCho/mI compared to pain-free patients, suggesting a link between neuroinflammation and neuropathic pain after spinal cord injury.

Study Duration

March 2016 and September 2018

Participants

24 patients with SCI (14 with NP, 10 pain-free) and 21 healthy controls

Evidence Level

Class II evidence, diagnostic accuracy study

Key Findings

1
Patients with neuropathic pain (NP) showed increased levels of tCho/mI compared to pain-free patients after spinal cord injury (SCI).
2
In patients with NP, higher tCho/mI levels were associated with less cord atrophy and greater pain sensation (better pinprick score).
3
Lower levels of tNAA/mI were associated with greater cord atrophy in pain-free patients with SCI.

Research Summary

This study investigated the relationship between neuroinflammatory and neurodegenerative metabolites in the cervical spinal cord and neuropathic pain (NP) in patients with spinal cord injury (SCI). The key finding was that patients with SCI and NP had elevated levels of tCho/mI, a marker of neuroinflammation, compared to pain-free patients. This elevation was also associated with less cord atrophy and greater pain sensation. The study suggests that tCho/mI levels could serve as a potential biomarker for neuropathic pain after SCI and could be used for patient stratification and therapy monitoring in clinical trials.

Practical Implications

Treatment Targets

Identifying tCho/mI as a potential biomarker opens new avenues for targeted therapies aimed at reducing neuroinflammation to alleviate neuropathic pain.

Patient Stratification

Cervical cord MRS could be used to stratify patients in interventional trials, allowing for more precise evaluation of treatment efficacy based on metabolite profiles.

Therapy Monitoring

Monitoring tCho/mI levels could provide a means to assess the effectiveness of different therapeutic interventions aimed at reducing neuroinflammation and managing neuropathic pain.

Study Limitations

1
The metabolites were measured as ratios, not absolute values, limiting the ability to draw conclusions on individual metabolite levels.
2
The spectroscopic voxel covers the entire cord, preventing measurement of individual tracts.
3
The sample size was relatively small, which may limit the generalizability of the findings.

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