Background & Aims

Although chronic pain has been documented as an important consequence of spinal cord injury (SCI), little is known about characteristics of both neuropathic and nociceptive pain in the pediatric SCI population. To date no systematic evaluation of the main SCI pain types has been performed in youth (1). The aim of this study was to document pain types in the pediatric-onset SCI population in accordance with the International Spinal Cord Injury Pain (ISCIP) Basic Data Set (2) and also with the neuropathic pain grading system (3). 

Methods

Fifty-one individuals with pediatric-onset SCI aged between 7–18 years with SCI present between the C7-L5 level (including cauda equina) diagnosed more than 6 months previously provided signed assent/consent to participate in this cross-sectional study (approval provided by the Toledo Hospital Complex Clinical Ethical Committee). Pain intensity was assessed with the numerical pain rating scale (4). Initial screening for neuropathic pain (NP) at and below the level of SCI was performed with the Douleur Neuropathique 4 (DN4) questionnaire. 

Results

A total of 51 individuals (age: 12.8 years ± 3.4; 52.9% females) with pediatric-onset SCI (time since injury: 8.1 ± 4.8 years) were recruited [ISCoS - International Spinal Cord Society data reporting format]: 6-12-year-olds (45%), 13-14-year-olds (19.6%), 15-17-year-olds (31.4%), and 18-21-year-olds (3.9%). Participants showed the following SCI neurological level and severity (ISCoS): C1-C4 ASIA Impairment Scale grade (AIS) A-B (5.9%) or C-D (15.7%), C5-C8 ASIA Impairment Scale grade (AIS) A-B (5.9%) or C-D (3.9%), and T1-S5 ASIA Impairment Scale grade (AIS) A-B (19.6%) or C-D (49%). Pain was reported in 43% of the cohort, with musculoskeletal pain (27.5%) and NP (15.7%; 7/51 below and 3/51 at level of SCI) present as the major pain types. The Pain intensity was present at a moderate level for participants with NP (6.4 ± 2.7) and nociceptive pain (musculoskeletal and visceral pain) (5.5 ± 2.1).

Conclusions

The present study reveals that chronic musculoskeletal pain is mostly associated in the pediatric-onset SCI, although a lower prevalence of NP. These data suggest the importance of an appropriate diagnosis of pain types for an effective clinical management in both the pediatric and adult this population (5).

References

1.      Jan FK, Wilson PE. A survey of chronic pain in the pediatric spinal cord injury population. J Spinal Cord Med. 2004;27 Suppl 1:S50-3. doi: 10.1080/10790268.2004.11753785.

2.      Widerström-Noga E, Biering-Sørensen F, Bryce TN, Cardenas DD, Finnerup NB, Jensen MP, Richards JS, Siddall PJ. The International Spinal Cord Injury Pain Basic Data Set (version 2.0). Spinal Cord. 2014;52(4):282-6. doi: 10.1038/sc.2014.4. 

3.      Finnerup NB, Haroutounian S, Kamerman P, Baron R, Bennett DLH, Bouhassira D et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain. 2016;157(8):1599-606. doi: 10.1097/j.pain.0000000000000492.

4.      Castarlenas E, Miró J, Sánchez-Rodríguez E. Is the verbal numerical rating scale a valid tool for assessing pain intensity in children below 8 years of age? J Pain. 2013;14(3):297-304. doi: 10.1016/j.jpain.2012.12.004. 

5.      Vogel LC, Krajci KA, Anderson CJ. Adults with pediatric-onset spinal cord injuries: part 3: impact of medical complications. J Spinal Cord Med. 2002;25(4):297-305. doi: 10.1080/10790268.2002.11753632.

 

Relevance for Patient Care

A better characterization of pain types in youth with pediatric-onset SCI could contribute to the development of a more effective multidisciplinary treatment approach. 

Ethical Permissions

This study protocol was approved by the local Clinical Research Ethics Committee (Approval number 784; 2021).