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Thread: Finnerup, et al. (2001): Pain and dysesthesia in patients with spinal cord injury

  1. #1

    Finnerup, et al. (2001): Pain and dysesthesia in patients with spinal cord injury

    • Finnerup NB, Johannesen IL, Sindrup SH, Bach FW and Jensen TS (2001). Pain and dysesthesia in patients with spinal cord injury: A postal survey. Spinal Cord. 39 (5): 256-62. Summary: STUDY DESIGN: A postal survey. OBJECTIVES: To assess the prevalence and characteristics of pain and dysesthesia in a community based sample of patients with spinal cord injury (SCI) with special focus on neuropathic pain. SETTING: Community. Western half of Denmark. METHODS: We mailed a questionnaire to all outpatients (n = 436) of the Viborg rehabilitation centre for spinal cord injury. The questionnaire contained questions regarding cause and level of spinal injury and amount of sensory and motor function below this level. The words pain and unpleasant sensations were used to describe pain (P) and dysesthesia (D) respectively. Questions included location and intensity of chronic pain or dysesthesia, degree of interference with daily activity and sleep, presence of paroxysms and evoked pain or dysesthesia, temporal aspects, alleviating and aggravating factors, McGill Pain Questionnaire (MPQ) and treatment. RESULTS: Seventy-six per cent of the patients returned the questionnaire, (230 males and 100 females). The ages ranged from 19 to 80 years (median 42.6 years) and time since spinal injury ranged from 0.5 to 39 years (median 9.3 years). The majority (> 75%) of patients had traumatic spinal cord injury. Of the respondents, 77% reported having pain or unpleasant sensations, and 67% had chronic pain or unpleasant sensations at or below lesion. Forty-eight per cent reported that P/D could be evoked by non-noxious stimulation of the skin indicating that allodynia is present in almost half of the patients. Forty-three per cent of respondents took analgesics, 7% received antidepressants or anticonvulsants. CONCLUSION: This survey suggests that pain and dysesthesia are common and serious complaints in SCI patients. Unexpectedly, only 7% of the patients were treated with drugs considered to be most effective in neuropathic pain. This emphasizes the need for a continued research and education on P/D in SCI. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11438841> Department of Neurology and Danish Pain Research Centre, University Hospital of Aarhus, Denmark.

  2. #2
    Senior Member Joe B's Avatar
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    Can this be right?

    At least 48% of these spinal cord injured people stated they are experiencing significant pain and dysesthesia and only 7% are getting medication. Why aren't the other 41% being treated?

    Amitryptiline is inexpensive and has been shown to be helpful for many persons with SCI pain. Neurontin is expensive but gives relief for many sufferers of central pain. I believe I get some relief from diazepam which is not expensive. Cant more be done than just surveying people with pain? Cant the doctors in other countries be informed of medications that may help

    Joe B

  3. #3
    Joe B, I was surprised by this statistic, too. So were the people who carried out the survey. I met a number of Danish neurologists who were part of this study recently and they were presenting the results of several clinical trials that they are conducting. Please understand that the use of tricyclic antidepressants for SCI pain is a relatively recent development. Note that 43% of the patients received other kinds of analgesics.

    This study may have reflected an earlier situation and do not represent the current treatment practice in Denmark. The Danes, Swedes, and Norwegians hve been devoting a lot of time and resources to the solution of SCI pain. I think that situation in Denmark will change in part because of studies like this.


    Wise.

  4. #4
    I think one of the significant factors in so many not receiving drugs is that there is no effective treatment for many with neuropathic pain. Doctors are able to treat periperal neuropathies with varying degrees of success depending on the patients and the specific condition, but central pain can be another matter altogether. I know that some people receive a degree of relief from things such as Neurontin, but I know people who recieve no help at all from that or any other drug.

    Aside from the fact that I'm not really qualified to offer medical advice, this is the biggest reason why PainOnline doesn't try to offer advice on treating central pain. I may someday relate anecdotal accounts of what people say has helped in some way or another, but I feel like I have an even bigger "mission" to warn of treatments that can wind up causing additional harm. The biggest problem I see is ablative surgery. The doctors that do this seem to get a little cocky because they have such high initial success ("There's no pain I can't cure"). What they fail to do is acknowledge how their patients feel one or two years down the road. Many have had the pain return, sometimes much worse than before.

    Ironically Neurontin, while it has undeniably helped many people, can also cause problems. One of the acknowledged side effect listed in Pfizer's own literature is dysesthesia, the complex neuropathic burning sensation. I personally know of one patient who almost surely had his central pain wholly caused by Neurontin. The bigger danger probably lies in cases where people are taking it for central pain and fail to realize that worsening symtoms are due to Neurontin, not is spite of it.

    Probably a little doctor education is in order here, but I doubt I'll bother asking Pfizer for a grant to support that effort.

    David Berg

    [This message was edited by David Berg on October 01, 2001 at 06:17 AM.]

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