Progress in treatment of pathological neuropathic pain after spinal cord injury

Pathological neuropathic pain is a frequent complication following spinal cord injury, marked by its persistence and resistance to treatment. Current treatments include medications like analgesics, anticonvulsants, and antidepressants, which often provide inadequate relief or cause severe side effects. Emerging strategies combine pharmacological and non-pharmacological approaches to improve pain management. The underlying mechanisms of neuropathic pain after spinal cord injury are complex, involving structural and functional changes in the nervous system, pain signal transmission, and inflammation. This complexity presents significant challenges to effective clinical management and necessitates a multifaceted approach to treatment. This review provides a comprehensive overview of existing literature, examining both the mechanisms and clinical interventions for pathological neuropathic pain following spinal cord injury. It aims to offer new insights for basic science research and improve clinical practices in the treatment of spinal cord injuries.

• 1
  Neuropathic pain following SCI involves alterations in normal sensory signals at peripheral, spinal cord, and supraspinal levels, leading to amplified pain perception.
• 2
  Key mechanisms at the spinal cord level include neuronal hyperexcitability, glial cell activation, altered calcium channel expression, immune-inflammatory responses, and neurotransmitter imbalances.
• 3
  At the supraspinal level, SCI disrupts signal transduction between the spinal cord and cerebral cortex, leading to structural plasticity changes in brain regions and alterations in brain metabolism.