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Section 4 - The Specific Condition: Central Neuropathic Pain

Published online by Cambridge University Press:  05 December 2013

Cory Toth
Affiliation:
Department of Neurology, University of Calgary
Dwight E. Moulin
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario
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Summary

Neuropathic pain after spinal cord injury (SCI) is a type of central neuropathic pain and is a frequent complication of spinal injury which is often refractory. Studies in animal models describe a number of peripheral and central pathophysiological processes after nerve injury that would be the basis of underlying neuropathic pain mechanisms. A major inhibitory system related to pain is opioid receptor mediated analgesia. In neuropathic pain, N-methyl-d-aspartate (NMDA) receptor activation increases excitation in the pain transmitting systems. Recent advances in pain research indicate multiple mechanisms, including many components of peripheral and central sensitization mechanisms, underlying the initiation and maintenance of neuropathic pain. Neurosurgical interventions may be treatment options in patients with poor pain control despite pharmacotherapy. Besides the effectiveness of a treatment, the adverse event profiles of these analgesics have to be considered before starting therapy or combining different agents.
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Chapter
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Neuropathic Pain
Causes, Management and Understanding
, pp. 145 - 176
Publisher: Cambridge University Press
Print publication year: 2013

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