Assessing and predicting neuropathic pain after spinal cord injury: a TRACK-SCI study

Neuropathic pain is one of the most common secondary complications occurring after spinal cord injury (SCI), and often surpasses motor and sensory deficits in the patient population preferences of the most important aspects to be treated. Despite the better understanding of the molecular and physiological mechanisms of neuropathic pain, reliable treatments are still lacking and exhibit wide variations in efficiency. Previous reports have suggested that the most effective pain management is early treatment. To this end, we utilized the TRACK-SCI prospective clinical research database to assess the neuropathic pain status of all enrolled patients and identify acute care variables that can predict the development of neuropathic pain 6- and 12-months post SCI. 36 out of 61 patients of our study cohort reported neuropathic pain at the chronic stages post SCI. Using multidimensional analytics and logistic regression we discovered that (1) the number of total injuries the patient sustained, (2) the injury severity score (ISS), (3) the lower limb total motor score, and (4) the sensory pin prick total score together predict the development of chronic neuropathic pain after SCI. The balanced accuracy of the corresponding logistic regression model is 74.3%, and repeated 5-fold cross validation showed an AUC of 0.708. Our study suggests a crucial role of polytrauma in chronic pain development after SCI and offers a predictive model using variables routinely collected at every hospital setting.

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Brain Networks With Modified Connectivity in Patients With Neuropathic Pain and Spinal Cord Injury

Clinical EEG and Neuroscience ◽

10.1177/15500594211051485 ◽

2021 ◽

pp. 155005942110514

Author(s):

Muhammad A. Hasan ◽

Parisa Sattar ◽

Saad A. Qazi ◽

Matthew Fraser ◽

Aleksandra Vuckovic

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Cluster Coefficient ◽

Brain Connectivity ◽

Study Cohort ◽

Pain Group ◽

Frequency Bands ◽

Local Efficiency ◽

Cord Injury

Background. Neuropathic pain (NP) following spinal cord injury (SCI) affects the quality of life of almost 40% of the injured population. The modified brain connectivity was reported under different NP conditions. Therefore, brain connectivity was studied in the SCI population with and without NP with the aim to identify networks that are altered due to injury, pain, or both. Methods. The study cohort is classified into 3 groups, SCI patients with NP, SCI patients without NP, and able-bodied. EEG of each participant was recorded during motor imagery (MI) of paralyzed and painful, and nonparalyzed and nonpainful limbs. Phased locked value was calculated using Hilbert transform to study altered functional connectivity between different regions. Results. The posterior region connectivity with frontal, fronto-central, and temporal regions is strongly decreased mainly during MI of dominant upper limb (nonparalyzed and nonpainful limbs) in SCI no pain group. This modified connectivity is prominent in the alpha and high-frequency bands (beta and gamma). Moreover, oscillatory modified global connectivity is observed in the pain group during MI of painful and paralyzed limb which is more evident between fronto-posterior, frontocentral-posterior, and within posterior and within frontal regions in the theta and SMR frequency bands. Cluster coefficient and local efficiency values are reduced in patients with no reported pain group while increased in the PWP group. Conclusion. The altered theta band connectivity found in the fronto-parietal network along with a global increase in local efficiency is a consequence of pain only, while altered connectivity in the beta and gamma bands along with a decrease in cluster coefficient values observed in the sensory-motor network is dominantly a consequence of injury only. The outcomes of this study may be used as a potential diagnostic biomarker for the NP. Further, the expected insight holds great clinical relevance in the design of neurofeedback-based neurorehabilitation and connectivity-based brain–computer interfaces for SCI patients.

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Acute traumatic quadriplegia: Predictors of in-hospital and six-month mortality

Trauma ◽

10.1177/1460408620909005 ◽

2020 ◽

Vol 22 (4) ◽

pp. 300-306

Author(s):

Ehsan Alimohammadi ◽

Paniz Ahadi ◽

Cyrous Rezaee ◽

Roya Safari-Faramani ◽

Seyed Reza Bagheri ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Logistic Regression ◽

Respiratory Failure ◽

Hospital Mortality ◽

Logistic Regression Model ◽

Injury Severity ◽

Traumatic Spinal Cord Injury ◽

Multiple Logistic Regression ◽

Cord Injury

Background Traumatic spinal cord injury is one of the most disastrous and devastating health burdens all over the world with a high mortality rate. The present study aimed to evaluate the predictors of in-hospital and six-month mortality in these patients. Methods The electronic medical records of 87 consecutive patients with acute complete traumatic quadriplegia were reviewed to extract clinical, radiological, and laboratory data. Simple and multiple logistic regression models were used to estimate crude and adjusted odds with 95% confidence interval (CI) ratios for the predictors of in-hospital mortality and six-month mortality. Results There were 48 males and the mean age was 38.67 ± 12.81; in-hospital and six-month mortality were 21.84% and 11.76%, respectively. Traffic road accidents (67.8%) and falls (12.6%) were the most common causes of injury. The univariate analysis demonstrated advanced age, level of injury, late surgery or no surgical intervention, the lack of methylprednisolone therapy, a higher Charlson comorbidity index, the Injury Severity Score, and the presence of respiratory failure or bradycardia on admission were predictors of in-hospital mortality ( p < 0.05). In the final multiple logistic regression model, the level of injury (OR = 0.02 (0.001,0.35), p = 0.008) and the presence of respiratory failure (OR = 2.37 (0.03,13.88), p = 0.024) were the only predictors of in-hospital mortality. The univariate model showed that the level of injury, respiratory failure on admission, and the Injury Severity Score were the predictors of six-month mortality; however, the level of injury was the only predictor of the six-month mortality (OR = 1.12 (0.99, 1.27), p = 0.028) according to the multiple logistic regression model. Conclusions Several factors could affect in-hospital and six-month mortality in patients with traumatic spinal cord injury. Our findings demonstrated the level of injury and respiratory failure on admission as independent predictors of in-hospital mortality in these patients. Furthermore, the level of injury was the only independent predictor of six-month mortality in the present study.

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Faculty Opinions recommendation of Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1098590.554694 ◽

2007 ◽

Author(s):

Nanna Finnerup

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Chronic Neuropathic Pain ◽

Cord Injury

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Users’ experiences of an evidence-informed health information website for spinal cord injury: A prospective qualitative study across the hospital and community setting (Preprint)

10.2196/preprints.20345 ◽

2020 ◽

Author(s):

Christina Cassady ◽

William Ben Mortenson ◽

Andrea F Townson ◽

Shannon Sproule ◽

Janice Jennifer Eng

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Health Information ◽

Information Needs ◽

Information Source ◽

Family Members ◽

Hospital Setting ◽

Community Setting ◽

Therapeutic Education ◽

Cord Injury

BACKGROUND Access to quality health information is essential for self-management after serious injuries such as spinal cord injury (SCI). OBJECTIVE The goal of this study was to evaluate the role of a consumer website in addressing the information needs of persons and families with SCI, as well as its impact on their knowledge and behaviour. METHODS Persons with SCI and family members were recruited from 3 settings: an acute hospital, a rehabilitation hospital, and an SCI community organization to acquire perspectives from early after injury to the chronic stage. Participants were introduced to the Spinal Cord Injury Research Evidence (SCIRE) Community website, which was an internet site developed to provide evidence-informed health information about SCI in everyday language. After using the SCIRE Community website for 4 weeks, semi-structured individual interviews were conducted to explore purposes of use, user experience, and impact on knowledge and behaviour. Interview transcripts were analyzed using qualitative thematic analysis. RESULTS The participants were 24 individuals (18 persons with SCI and 6 family members). Thirteen participants completed the study in a hospital setting and 11 participants in a community setting. We identified 3 main themes in the data: (1) ‘An internet tool to support and empower persons and families’ described the empowering nature of access to an independent information source which enabled persons and families with SCI to take a more active role in their care; (2) ‘an accessible source of credible information’ described how users valued easy to access content with oversight by experts (i.e., perceived to be trustworthy); and (3) ‘Opportunities to increase impact’ outlined suggestions on creating opportunities to engage with content through active learning strategies and community connections. CONCLUSIONS Persons and families with SCI valued having access to an independent online health information website, especially early after injury, as it helped to empower autonomy and facilitated better communication between persons and families and healthcare providers. Our study provides support for the value of internet-based health information as a supplementary tool for therapeutic education for persons and families with serious health conditions such as SCI.

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Development of Predictive Informatics Tool Using Electronic Health Records to Inform Personalized Evidence-Based Pressure Injury Management for Veterans with Spinal Cord Injury

Military Medicine ◽

10.1093/milmed/usaa469 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 651-658

Author(s):

Kath M Bogie ◽

Steven K Roggenkamp ◽

Ningzhou Zeng ◽

Jacinta M Seton ◽

Katelyn R Schwartz ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Spinal Cord ◽

Spinal Cord Injury ◽

User Interface ◽

Veterans Health Administration ◽

Study Cohort ◽

Veterans Health ◽

Health Administration ◽

Cord Injury

ABSTRACT Background Pressure injuries (PrI) are serious complications for many with spinal cord injury (SCI), significantly burdening health care systems, in particular the Veterans Health Administration. Clinical practice guidelines (CPG) provide recommendations. However, many risk factors span multiple domains. Effective prioritization of CPG recommendations has been identified as a need. Bioinformatics facilitates clinical decision support for complex challenges. The Veteran’s Administration Informatics and Computing Infrastructure provides access to electronic health record (EHR) data for all Veterans Health Administration health care encounters. The overall study objective was to expand our prototype structural model of environmental, social, and clinical factors and develop the foundation for resource which will provide weighted systemic insight into PrI risk in veterans with SCI. Methods The SCI PrI Resource (SCI-PIR) includes three integrated modules: (1) the SCIPUDSphere multidomain database of veterans’ EHR data extracted from October 2010 to September 2015 for ICD-9-CM coding consistency together with tissue health profiles, (2) the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) developed from the cohort’s free text clinical note (Text Integration Utility) notes, and (3) the clinical user interface for direct SCI-PIR query. Results The SCI-PIR contains relevant EHR data for a study cohort of 36,626 veterans with SCI, representing 10% to 14% of the U.S. population with SCI. Extracted datasets include SCI diagnostics, demographics, comorbidities, rurality, medications, and laboratory tests. Many terminology variations for non-coded input data were found. SCIPUDO facilitates robust information extraction from over six million Text Integration Utility notes annually for the study cohort. Visual widgets in the clinical user interface can be directly populated with SCIPUDO terms, allowing patient-specific query construction. Conclusion The SCI-PIR contains valuable clinical data based on CPG-identified risk factors, providing a basis for personalized PrI risk management following SCI. Understanding the relative impact of risk factors supports PrI management for veterans with SCI. Personalized interactive programs can enhance best practices by decreasing both initial PrI formation and readmission rates due to PrI recurrence for veterans with SCI.

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1-kHz high-frequency spinal cord stimulation alleviates chronic refractory pain after spinal cord injury: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00451-x ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Chiaki Yamada ◽

Aiko Maeda ◽

Katsuyuki Matsushita ◽

Shoko Nakayama ◽

Kazuhiro Shirozu ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Cervical Vertebrae ◽

Intractable Pain ◽

Target Area ◽

Positive Effects ◽

Cord Injury

Abstract Background Patients with spinal cord injury (SCI) frequently complain of intractable pain that is resistant to conservative treatments. Here, we report the successful application of 1-kHz high-frequency spinal cord stimulation (SCS) in a patient with refractory neuropathic pain secondary to SCI. Case presentation A 69-year-old male diagnosed with SCI (C4 American Spinal Injury Association Impairment Scale A) presented with severe at-level bilateral upper extremity neuropathic pain. Temporary improvement in his symptoms with a nerve block implied peripheral component involvement. The patient received SCS, and though the tip of the leads could not reach the cervical vertebrae, a 1-kHz frequency stimulus relieved the intractable pain. Conclusions SCI-related symptoms may include peripheral components; SCS may have a considerable effect on intractable pain. Even when the SCS electrode lead cannot be positioned in the target area, 1-kHz high-frequency SCS may still produce positive effects.

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