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MANAGING CHRONIC PAIN SYNDROMES FOLLOWING SPINAL CORD INJURY Martin Grabois, M.D. Professor and Chairman, Physical Medicine and Rehabilitation; Professor,

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Presentation on theme: "MANAGING CHRONIC PAIN SYNDROMES FOLLOWING SPINAL CORD INJURY Martin Grabois, M.D. Professor and Chairman, Physical Medicine and Rehabilitation; Professor,"— Presentation transcript:

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2 MANAGING CHRONIC PAIN SYNDROMES FOLLOWING SPINAL CORD INJURY Martin Grabois, M.D. Professor and Chairman, Physical Medicine and Rehabilitation; Professor, Anesthesiology Baylor College of Medicine Houston, Texas

3 Managing Chronic Pain Syndromes Following Spinal Cord Injury Presentation Goals 1.Understand the significance of the problem looking at demographic information. 2.Appreciation of various classification systems available and utilizing one as the source of the discussion. 3.Discussion on general evaluation technique and treatment options. 4.Presentation of the different syndromes seen from their characteristics, evaluation and treatment techniques. 5.Appreciation of the results that can be achieved.

4 Managing Chronic Pain Syndromes Following Spinal Cord Injury Prevalence Difference in methods and population make direct comparison difficult YearAuthorN% Pain 1947Davis et al Bitterek et al Nepomuecno et al Woolsey Kumar et al Rose et al Britell et al PVA Survey912 45

5 Managing Chronic Pain Syndromes Following Spinal Cord Injury Classification Concepts Site of TraumaRadicular Below Level of LesionCentral Pain MS PainPsychological Syringomyelia VisceralRSD

6 Managing Chronic Pain Syndromes Following Spinal Cord Injury Classification System Pain Visceral Somatic Superficial CentralPsychic Deep InitialDelayed Conduction Conduction Conduction Conduction Preoccupation From From FromFrom Within Skin Connective Tissue Viscera, E.G. CNS E.G. Cognitive Peripheral Nerve Muscles Bowels Cord Processes Bones Bladder Thalamus

7 Managing Chronic Pain Syndromes Following Spinal Cord Injury TIRR Classification System Segmental Pain Spinal Cord Pain Visceral Pain Mechanical Pain Psychic Pain

8 Managing Chronic Pain Syndromes Following Spinal Cord Injury Evaluation History Physical Exam Functional Psycho-Social Pain Questionnaire

9 Managing Chronic Pain Syndromes Following Spinal Cord Injury Evaluation Clinical: History and Physical Functional Psychosocial Diagnostic Tests

10 Managing Chronic Pain Syndromes Following Spinal Cord Injury The Reliability of Pain Classification Pain ClassDiagnosedConfirmedReliability Central % Musculoskeletal % Syringomyelic %

11 Managing Chronic Pain Syndromes Following Spinal Cord Injury Anatomy of the Pain System Central Control Process Motor Mechanisms Motivational-Affective System (Central Intensity Monitor) Sensory-Discriminative Sysem (Spatio-Temporal Analysis) Gate Control System L Input S

12 Managing Chronic Pain Syndromes Following Spinal Cord Injury PAIN SYNDROMES Pain TypeTime of Onset CharacterDurationAggravatingDiminishingPossible Causative Post Injury FactorsFactorFactors Segmental Days to weeks Burning; stabbingSecondsRestActivitySlow fibre conduction Cauda equinafrom skin Spinal CordWeeks to Tingling; numbnessConstantActivityRestAll fibre conduction months within cord VisceralWeeks to BurningConstantVariableVariableSlow fibre conduction monthsfrom viscera MechanicalWeeks to Dull; achingVariableActivityRestSlow fibre conduction monthsfrom muscle or ligaments PsychicVariable VariableVariableVariableVariablePreoccupation with unpleasant environmental stimuli

13 Managing Chronic Pain Syndromes Following Spinal Cord Injury Treatment of Spinal Cord Injury Pain Syndromes Classification DrugPTBlocksPsycho-SocialSurgery Segmental TregretalTENSNerveDoral Root Ent BlocksZone Cordotom Spinal Cord TricylicEpidural Anti-Stimulation depressants Baclofen Anti- convulsants Visceral ValiumHeat, Ice, NSAIDTens, US, Position Mofication PsychicBehavior modification Psychosocial intervention

14 Managing Chronic Pain Syndromes Following Spinal Cord Injury Deafferentation Pain After Spinal Cord Injury Percentage Acetaminophen__________________________________ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Aspirin______________________________________________ __ __ __ __ __ __ __ __ __ Diazepang________________ __ __ __ __ Propoxyphene______________ __ __ __ __ __ __ __ __ __ Oxycodone Hydrochloride____ __ __ Acataminophen Oxycodone Hydro-__ __ __ __ __ __ __ __ chloride Morphine Hydrochloride__ __ __ __ __ __ __ __ __ __ __ __ Meperidine Hydrochloride Propoxyphene Napsylate__ __ __ __ __ __ __ __ __ __ __ __ [Key: ________Used Before Injury __ __ __ Used After Injury]

15 Managing Chronic Pain Syndromes Following Spinal Cord Injury Chronic Pain Modifier Questionnaire SubstanceIncreases PainDecreases PainHave/Has No Effect on Pain Cigarettes0% 0%100% Beer0%100% 0% Marijuana0%100% 0% Acetaminophen0% 66% 34% Wine0%100% 0% Mixed Drinks0% 75% 25% Aspirin0% 60% 40% Diazapam0%100% 0% Lioresal0% 60% 40% Clonazepam0% 0% 0% Heroin0%100% 0% Cocaine0%100% 0% Crack0% 0% 0% Propoxyphene0% 50% 50% Oxycodone Hydro-0% 66% 34% chloride Acetaminophen0% 66% 34% Oxycodone Hydro- chloride Morphine Hydrochloride0% 0% 0% Meperdine Hydro-0%100% 0% chloride Propoxyphene0% 75% 25% Napsylate Others0% 0%100%

16 Managing Chronic Pain Syndromes Following Spinal Cord Injury Summary

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