One of the most dangerous complications of spinal-cord injury is a spastic syndrome - a condition when the patient has difficulty to bend or straighten the limb due to the strong muscle tone. There are two types of spastic syndromes: phasic and tonic, depending on the types of muscle fibers predominantly involved in their formation. Tonic spastic syndromes occur in many neurological diseases and are usually one of the components of the central (pyramidal) paresis or paralysis developing in various lesions of the brain or spinal cord. The most common causes are stroke, traumatic brain and spinal injuries. Phasic spastic syndrome include various manifestations of painful muscle spasms.
The causes of spastic syndromes vary. They include effects of traumatic brain injury and spinal cord injury, acute cerebrovascular accidents (cerebral and spinal stroke), neurodegenerative diseases (multiple sclerosis), effects of operations.
Neuropathic pain is from 25 to 50% of all pain syndromes with which patients come to the Clinic. A distinctive feature of severe neuropathic pain is a partial absence of analgesic effect of the use of narcotic analgesics.
- neuropathic pain for most is characterized bythe combination of constant pain, against which there are paroxysms of intense pain. Background pain is often the nature of the unusual, poorly localized, diffuse feelings. Pathognomonic are considered its definitions such as "burning", "scorching", "icy", "aching", "squeezing", "itchy". A sudden sharp (paroxysmal) pain is described as "piercing", "jerking", "tearing", "sweep", "electric shock";
- in most cases, neurogenic pain is marked by sensory disturbances;
- autonomic and trophic disordersare characteristic;
- pain often increases or causes itself emotionnal stress disorders;
- unexplained feature of even severe neuropathic pain is that it does not interfere with the patient falling asleep. At the same time, patients often wake up in the night from the intense pain.
Neuropathic pain is resistant to morphine and other opiates in the usual analgesic doses. This demonstrates the difference between the mechanism of neuropathic pain and opioid-sensitive pain. This criterion is one of the main features in a series of features of severe drug-resistant neuropathic pain.
Methods of treatment
- Neurostimulation of spinal cord in spastic conditions and pain syndromes