Pain and spasticity after spinal cord injury: mechanisms and treatment.
METHODS
A comprehensive survey of literature on the proposed mechanisms and treatment of pain and spasticity after spinal cord injury (SCI) was completed.


OBJECTIVE
To define the current understanding of these entities and to review various treatment options.


BACKGROUND
The neurophysiologic basis of spasticity after SCI is well established. The mechanism of neuropathic pain after SCI remains conjectural, although considerable new data, much of it from animal models, now add to our understanding of this condition.


METHODS
A comprehensive search and review of the published literature was undertaken.


RESULTS
Treatment options for spasticity are effective and include oral medication (baclofen, tizanidine), intrathecal baclofen, and rarely, surgical rhizotomy or myelotomy. Selected patients with post-SCI pain can respond to surgical myelotomy (DREZ lesions) or intrathecal agents (e.g., morphine + clonidine), but the majority continue to suffer.


CONCLUSIONS
Medical and surgical treatments for spasticity are established and highly successful. Management of post-SCI pain remains a clinical challenge, as there is no uniformly successful medical or surgical treatment.
Burchiel
K J
KJ
Department of Neurological Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA. burchiek@ohsu.edu
Hsu
F P
FP
D000818:Animals; D002908:Chronic Disease; D004195:Disease Models, Animal; D006801:Humans; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology