Spacticity and Neuropathic Pain Syndromes
Spastic syndrome
One of the most dangerous complications of spinal cord injury is spastic syndrome - a condition when the patient has difficulty bending or straightening a limb due to a strong increase in muscle tone. There are two types of spastic syndromes: tonic and phasic, depending on which types of muscle fibers are predominantly involved in their formation. Tonic spastic syndromes occur in many neurological diseases and are usually one of the components of central (pyramidal) paresis or paralysis that develops with various lesions of the brain or spinal cord. The most common causes are strokes, craniocerebral and spinal injuries. Phasic spastic syndromes include various manifestations of painful muscle spasms.
The causes of spastic syndromes are very diverse. These include the consequences of traumatic brain injuries and spinal cord injuries, acute cerebrovascular accidents (cerebral and spinal strokes), neurodegenerative diseases (multiple sclerosis), and the consequences of neurosurgical interventions.
Pain Syndromes
Neuropathic pain accounts for 25 to 50% of all pain syndromes with which patients seek medical help. A distinctive feature of severe neuropathic pain syndrome is the frequent absence of an analgesic effect from the use of narcotic analgesics.
Symptoms
- The most characteristic feature of neuropathic pain is a combination of constant pain, against the background of which paroxysms of intense pain occur. Background pain often has the character of an unusual, poorly localized, diffuse sensation. The following definitions are considered pathognomonic for it: "burning", "scorching", "scalding", "chilling", "aching", "squeezing", "itching". Sudden acute (paroxysmal) pain is described as "piercing", "twitching", "tearing", "shooting", "electric shock";
- in the vast majority of cases of neurogenic pain, sensitivity disorders are noted;
- vegetative and trophic disorders are characteristic;
- pain often intensifies or itself causes emotional and stressful disorders;
- an inexplicable characteristic feature of even sharp neurogenic pain is that it does not interfere with the patient's sleep. At the same time, patients often wake up in the middle of the night from intense pain.
Neuropathic pain is unresponsive to morphine and other opiates in conventional analgesic doses. This demonstrates the difference in the mechanism of neuropathic pain from opioid-sensitive nociceptive pain. This criterion is one of the main ones in a series of signs of severe drug-resistant neuropathic pain syndrome.