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Spinal Cord (2016) 54, S14S23 Ofcial Journal of the International Spinal Cord Society
http://www.nature.com/sc
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GUIDELINES
The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: Recommendations for treatment
SD Guy1,2, S Mehta1,2, A Casalino3, I Ct4, A Kras-Dupuis3, DE Moulin2,5, AG Parrent2,6, P Potter2,3,C Short7, R Teasell1,2,3, CL Bradbury8, TN Bryce9, BC Craven8, NB Finnerup10, D Harvey11, SL Hitzig8,12, B Lau13, JW Middleton14, C OConnell15,16, S Orenczuk3, PJ Siddall14, A Townson13, C Truchon17,E Widerstrm-Noga18, D Wolfe1,3 and E Loh1,2,3
Study design: Clinical practice guidelines.
Objectives: To develop the rst Canadian clinical practice guidelines for treatment of neuropathic pain in people with spinal cord injury (SCI).
Setting: The guidelines are relevant for inpatient and outpatient SCI rehabilitation settings in Canada.
Methods: The CanPainSCI Working Group reviewed the evidence for different treatment options and achieved consensus. The Working Group then developed clinical considerations for each recommendation. Recommendations for research are also included.
Results: Twelve recommendations were developed for the management of neuropathic pain after SCI. The recommendations address both pharmacologic and nonpharmacologic treatment modalities.
Conclusions: An expert Working Group developed recommendations for the treatment of neuropathic pain after SCI that should be used to inform practice.
Spinal Cord (2016) 54, S14S23; doi:http://dx.doi.org/10.1038/sc.2016.90
Web End =10.1038/sc.2016.90
SCI-related NP is reducing pain severity sufciently to support functional improvement.
Mechanisms operating at the spinal, peripheral and cerebral level may contribute to the development of post-SCI NP. Some experimental ndings indicate that SCI-related NP may originate in the spinal cord near the site of damage and involve secondary changes in damaged nerve roots and brain structures.3 Excitotoxic and inammatory processes that decrease inhibition and alter descending modulation may produce functional changes in surviving neurons and cortical and subcortical structures.4 Pharmacologic studies suggest that reducing membrane excitability and glutamate receptor activation (lidocaine and ketamine), increasing neuronal inhibition (baclofen and propofol) or blocking either sodium (lamotrigine) or calcium (pregabalin) channels involved in hyperexcitability may be effective for SCI-related NP.
Currently available treatment options, which target pathophysiologic changes at peripheral, spinal and cerebral levels, include both pharmacologic and nonpharmacologic approaches.3 Pharmacologic options include anticonvulsants, antidepressants and opioids. Nonpharmacologic approaches, which encompass stimulation
1Lawson Health Research Institute, London, Ontario, Canada; 2Western University, London, Ontario, Canada; 3Parkwood...