Neurology

Spinal Cord Injury

September 2001

Clinical Focus*

Issues Related to Assessment

• What are the measurement properties (reliability, validity, and responsiveness) of:
  1. Assessment approaches for chronic central neuropathic pain (CNP) per se (including criteria and tools such as inventories, questionnaires, and scales)?
  2. Other outcome measures or assessments (related to the experience of pain)?
  3. Assessment approaches (including criteria and tools such as inventories, questionnaires, and scales) to identify new onset musculoskeletal pain against a background of chronic CNP?
• What is the strength of evidence for strategies for the differential diagnosis of chronic CNP from other types of pain?

Issues Related to Natural History

• What is the strength of evidence for identifying the prevalence of acute and chronic CNP, and factors that could predict the development of chronic CNP?

Issues Related to Interventions for Treatment

• What is the evidence for the effectiveness and safety of each of the following classes of medications:
  1. Simple analgesics (including nonsteroidal antiinflammatory drugs [NSAIDs] and acetaminophen), antidepressants (including tricyclics and selective serotonin reuptake inhibitors [SSRIs]), antiseizure medication, narcotics, muscle relaxants, N-methyl-D-aspartate (NMDA) antagonists, and local anesthetics?
  2. How do these classes of medication compare with each other?
  3. What is the strength of evidence for the effectiveness and safety of treatment algorithms including these classes of medication?
• What is the evidence of effectiveness and safety of:
  1. Transcutaneous electrical nerve stimulation (TENS).
  2. Nerve blocks (regional anesthetic interventions).
  3. Surgery, including dorsal root entry zone (DREZ).
  4. Multidisciplinary pain treatment approaches.
  5. Pain management approaches.
  6. Comprehensive pain management clinics.
  7. Psychosocial interventions.
• What is the evidence for the effectiveness and safety of self-management approaches to chronic pain management (e.g., Catalano's workbook, Caudill's workbook, Aspen's pain management education manual, Tollison's pain management patient guide)?

*Addressed in the summary or evidence report.

Management of Chronic Neuropathic Pain Following Traumatic Spinal Cord Injury
Summary (Publication No. 01-E062, September 2001)
Evidence Report (Publication No. 01-E063, September 2001)
(File Download)

EPC: McMaster University
Topic Nominator: Consortium for Spinal Cord Medicine

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