A number of high-quality studies have recently been published that examine the association between neuropathic pain and health-related quality of life (HRQoL). The current review identified 52 such studies in patients with six neuropathic pain conditions associated with lesions of either the peripheral (postsurgical neuropathic pain associated with breast and amputation surgery, postherpetic neuralgia, and painful diabetic neuropathy) or central (poststroke pain, spinal cord injury pain, multiple sclerosis pain) nervous system. The results provide strong evidence that the presence and severity of neuropathic pain are associated with greater impairments in a number of important HRQoL domains. However, the evidence also indicates that this impact varies somewhat as a function of the HRQoL domain being considered and that different measures of HRQoL are differentially sensitive to the effects of neuropathic pain. The findings have important implications for the selection of HRQoL domains and measures to use in clinical trials and in clinical research on HRQoL in persons with neuropathic pain and suggest that a biopsychosocial (as opposed to a primarily biomedical) approach would be appropriate for understanding and treating neuropathic pain.

The impact of neuropathic pain on health-related quality of life: Review and implications

Chronic pain is an important problem following spinal cord injury (SCI) and is a major impediment to effective rehabilitation. The reported prevalence of chronic SCI pain is variable but averages 65% with around one third of these people rating their pain as severe. The mechanisms responsible for the presence of pain are poorly understood. However, evidence from clinical observations and the use of animal models of SCI pain suggests that a number of processes may be important. These include functional and structural plastic changes in the central nervous system following injury, with changes in receptor function and loss of normal inhibition resulting in an increased neuronal excitability. A number of specific types of SCI pain can be distinguished based on descriptors, location and response to treatment. Nociceptive pain can arise from musculoskeletal structures and viscera and neuropathic pain can arise from spinal cord and nerve damage. The role of psychological and environmental factors also needs to be considered. Accurate identification of these pain types will help in selecting appropriate treatment approaches. Current treatments employ a variety of pharmacological, surgical, physical and psychological approaches. However, evidence for many of the treatments in use is still limited. It is hoped that future research will identify effective treatment strategies that accurately target specific mechanisms.

/pdf/pain-following-spinal-cord-injury-4g9kytt0aq.pdf

Pain following spinal cord injury.

Little research has examined the role of patient cognitive and behavioral responses, including catastrophizing, in adjustment to chronic pain associated with spinal cord injury (SCI). The objective of this study was to examine the associations of catastrophizing and specific pain coping strategies with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain and SCI, after controlling for important demographic and SCI-related variables that might affect outcomes. Participants in this study were 174 community residents with SCI and chronic pain who completed a mailed questionnaire that included the SF-36 Mental Health scale, Coping Strategies Questionnaire, and Graded Chronic Pain Scale. The pain coping and catastrophizing measures explained an additional 29% of the variance in pain intensity after adjusting for the demographic and SCI variables (P<0.001). The coping and catastrophizing scales accounted for an additional 30% of the variance in psychological distress (P<0.001) and 11% of the variance in pain-related disability (P<0.001), after controlling for pain intensity and demographic and SCI variables. Catastrophizing, but not any other single pain coping strategy, was consistently strongly and independently associated with the outcome measures. Potentially, the assessment and treatment of catastrophizing may reduce psychological distress and pain-related disability among individuals with chronic pain and SCI.

Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ejp.905

Neuropathic pain prevalence following spinal cord injury: A systematic review and meta-analysis

Discussion of issues and development of consensus. Present the background, purpose, development process, format and definitions of the International Spinal Cord Injury Pain (ISCIP) Classification. An international group of spinal cord injury (SCI) and pain experts deliberated over 2 days, and then via e-mail communication developed a consensus classification of pain after SCI. The classification was reviewed by members of several professional organizations and their feedback was incorporated. The classification then underwent validation by an international group of clinicians with minimal exposure to the classification, using case study vignettes. Based upon the results of this study, further revisions were made to the ISCIP Classification. An overall structure and terminology has been developed and partially validated as a merger of and improvement on previously published SCI pain classifications, combined with basic definitions proposed by the International Association for the Study of Pain and pain characteristics described in published empiric studies of pain. The classification is designed to be comprehensive and to include pains that are directly related to the SCI pathology as well as pains that are common after SCI but are not necessarily mechanistically related to the SCI itself. The format and definitions presented should help experienced and non-experienced clinicians as well as clinical researchers classify pain after SCI.

/pdf/international-spinal-cord-injury-pain-classification-part-i-7w74xsrx28.pdf

International Spinal Cord Injury Pain Classification: part I. Background and description

Transcutaneous auricular vagus nerve stimulation (taVNS) has been proposed to activate the locus ceruleus-noradrenaline (LC-NA) system. However, previous studies failed to find consistent modulatory effects of taVNS on LC-NA biomarkers. Previous studies suggest that phasic taVNS may be capable of modulating LC-NA biomarkers such as pupil dilation and alpha oscillations. However, it is unclear whether these effects extend beyond pure sensory vagal nerve responses. Critically, the potential of the pupillary light reflex as an additional taVNS biomarker has not been explored so far. Here, we applied phasic active and sham taVNS in 29 subjects (16 female, 13 male) while they performed an emotional Stroop task (EST) and a passive pupil light reflex task (PLRT). We recorded pupil size and brain activity dynamics using a combined Magnetoencephalography (MEG) and pupillometry design. Our results show that phasic taVNS significantly increased pupil dilation and performance during the EST. During the PLRT, active taVNS reduced and delayed pupil constriction. In the MEG, taVNS increased frontal-midline theta and alpha power during the EST, whereas occipital alpha power was reduced during both the EST and PLRT. Our findings provide evidence that phasic taVNS systematically modulates behavioral, pupillary, and electrophysiological parameters of LC-NA activity during cognitive processing. Moreover, we demonstrate for the first time that the pupillary light reflex can be used as a simple and effective proxy of taVNS efficacy. These findings have important implications for the development of noninvasive neuromodulation interventions for various cognitive and clinical applications. SIGNIFICANCE STATEMENT taVNS has gained increasing attention as a noninvasive neuromodulation technique and is widely used in clinical and nonclinical research. Nevertheless, the exact mechanism of action of taVNS is not yet fully understood. By assessing physiology and behavior in a response conflict task in healthy humans, we demonstrate the first successful application of a phasic, noninvasive vagus nerve stimulation to improve cognitive control and to systematically modulate pupillary and electrophysiological markers of the noradrenergic system. Understanding the mechanisms of action of taVNS could optimize future clinical applications and lead to better treatments for mental disorders associated with noradrenergic dysfunction. In addition, we present a new taVNS-sensitive pupillary measure representing an easy-to-use biomarker for future taVNS studies.

Phasic, Event-Related Transcutaneous Auricular Vagus Nerve Stimulation Modifies Behavioral, Pupillary, and Low-Frequency Oscillatory Power Responses

http://www.brainstimjrnl.com/article/S1935861X23017989/pdf

Effects of transcutaneous auricular vagus nerve stimulation paired with tones on electrophysiological markers of auditory perception

The aim of the multicentre study* entitled `Description and Documentation of Painful States in Spinal Cord Injury Patients', in addition to the description and documentation of chronic pain and stressful dysaesthesiae in SCI patients, was the search for correlations between these symptoms and medical and psychosocial variables. To this end, the sample was selected to be as representative as possible. All patients referred for in-patient or out-patient treatment at the centres taking part were enrolled in the study in order of presentation, providing they gave consent and met the inclusion criteria. Psychosocial, medical and demographic data were elicited by a standardized battery of questions and a standardized physical examination, as were any chronic pain/dysaesthesiae (P/D) present in any localization. Among 901 patients, 34% had no chronic pain or dysaesthesiae, 50% had pain only, 11% had painful dysaesthesiae and 5%, non-painful but chronic and distressing dysaesthesiae. The intensity of P/D was noted as seven or more on a 10 cm visual analogue scale by 61% of the patients affected and was experienced as rather or very distressing in 75% of cases. Most (86%) P/D were located below the spinal lesion or in the transition zone. There were significant correlations between the presence of P/D and age on questioning and at onset of the paraplegia/tetraplegia, problems with rectal paralysis, expectations of life as a paraplegic/tetraplegic, and subjective assessment of changes in working life. Highly significant correlations were found with subjective distress resulting of paraplegia/tetraplegia as such, depressed mood and psychosomatic disturbances of wellbeing. Overall, among the selected variables of our study, we found that correlations between P/D and psychosocial variables were more frequent and closer than those between P/D and medical variables.

/pdf/chronic-pain-dysaesthesiae-in-spinal-cord-injury-patients-2u2i0s2j3t.pdf

Chronic pain/dysaesthesiae in spinal cord injury patients: results of a multicentre study.

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Phasic, Event-Related Transcutaneous Auricular Vagus Nerve Stimulation Modifies Behavioral, Pupillary, and Low-Frequency Oscillatory Power Responses

Effects of transcutaneous auricular vagus nerve stimulation paired with tones on electrophysiological markers of auditory perception

Chronic pain/dysaesthesiae in spinal cord injury patients: results of a multicentre study.