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The progression of neuropathic pain after acute spinal cord injury: A meta-analysis and framework for clinical trials


Warner, Freda; Cragg, Jacquelyn J; Jutzeler, Catherine; Finnerup, Nana; Werhagen, Lars; Weidner, Norbert; Maier, Doris; Kalke, Yorck-Bernhard; Curt, Armin; Kramer, John (2019). The progression of neuropathic pain after acute spinal cord injury: A meta-analysis and framework for clinical trials. Journal of Neurotrauma, 36(9):1461-1468.

Abstract

The translation of therapeutic interventions to humans with spinal cord injury with the goal promoting growth and repair in the central nervous system could, inadvertently, drive mechanisms associated with the development of neuropathic pain. A framework is needed in order to evaluate the probability that a therapeutic intervention for acute spinal cord injury modifies the progression of neuropathic pain. We analyzed a large, longitudinal dataset from the European Multi-Center Study about Spinal Cord Injury (EMSCI) and compared these observations to a previously published Swedish/Danish cohort. A meta-analysis was performed to produce aggregate estimates for the transition period between 1-6 months and the transition period between 1-12 months after injury. A secondary analysis used logistic regression to explore associations between the progression of neuropathic pain and demographics, pain characteristics, and injury characteristics. For overall neuropathic pain, 72% presenting with pain symptoms at 1 month reported persisting symptoms at 6 months, and 23% who did not have neuropathic pain at 1-month later developed it. From 1-12 months, there was a similar likelihood of pain persisting (69%), and slightly higher rate of pain developing (36%). Characteristics that were significantly associated with the progression of pain included age and sensory and motor preservation. We provide historical benchmarks for estimating the progression of neuropathic pain during the first year after acute SCI. This information will be useful for comparison and evaluating safety during early phase acute spinal cord injury trials.

Abstract

The translation of therapeutic interventions to humans with spinal cord injury with the goal promoting growth and repair in the central nervous system could, inadvertently, drive mechanisms associated with the development of neuropathic pain. A framework is needed in order to evaluate the probability that a therapeutic intervention for acute spinal cord injury modifies the progression of neuropathic pain. We analyzed a large, longitudinal dataset from the European Multi-Center Study about Spinal Cord Injury (EMSCI) and compared these observations to a previously published Swedish/Danish cohort. A meta-analysis was performed to produce aggregate estimates for the transition period between 1-6 months and the transition period between 1-12 months after injury. A secondary analysis used logistic regression to explore associations between the progression of neuropathic pain and demographics, pain characteristics, and injury characteristics. For overall neuropathic pain, 72% presenting with pain symptoms at 1 month reported persisting symptoms at 6 months, and 23% who did not have neuropathic pain at 1-month later developed it. From 1-12 months, there was a similar likelihood of pain persisting (69%), and slightly higher rate of pain developing (36%). Characteristics that were significantly associated with the progression of pain included age and sensory and motor preservation. We provide historical benchmarks for estimating the progression of neuropathic pain during the first year after acute SCI. This information will be useful for comparison and evaluating safety during early phase acute spinal cord injury trials.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 May 2019
Deposited On:27 Nov 2018 14:52
Last Modified:24 Sep 2019 23:53
Publisher:Mary Ann Liebert
ISSN:0897-7151
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1089/neu.2018.5960
PubMed ID:30417730

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