High Prevalence of Neuropathic Pain After Spinal Cord Injury

Neuropathic pain is highly prevalent following spinal cord injury (SCI), according to findings published in the Journal of Clinical Neuroscience.

Researchers conducted a meta-analysis to determine the pooled prevalence and predictors of neuropathic pain following SCI using validated diagnostic tools. They searched PubMed, Medline, Scopus, and Web of Science databases through March 17, 2024, for studies reporting neuropathic pain prevalence in adults with SCI based on standardized classification systems. Eligible studies included cross-sectional, prospective, and retrospective cohorts that assessed neuropathic pain using instruments such as the International SCI Pain (ISCIP) classification, Douleur Neuropathique 4 (DN4), and Leeds Assessment of Neuropathic Symptoms and Signs. Study quality was evaluated using an adapted Newcastle–Ottawa Scale.

A total of 24 studies encompassing 6318 participants were analyzed. Across studies, participant age (mean or median) ranged from 24.9 to 64.5 years, and men comprised 64.6% to 100% of participants. Roughly half of the cases were of traumatic etiology (50.6%), and 40.6% involved tetraplegia.

Despite challenges with study heterogeneity and methodological differences, our findings highlight the need for standardized diagnostic tools and early interventions to improve quality of life.

The pooled prevalence of neuropathic pain after SCI was 57% (95% CI, 51%–64%), with significant between-study heterogeneity (I²=96.2%) but no evidence of publication bias.

Subgroup analyses showed neuropathic pain prevalence of 30% for below-level pain, 20% for at-level pain, and 5% for simultaneous at- and below-level pain. Age, sex, cause of injury, severity, time since injury, and neurologic level were not significantly associated with neuropathic pain prevalence. However, the diagnostic tool used significantly affected prevalence estimates (P <.01). Studies using the ISCIP system reported a pooled prevalence of 53%, compared with 49% in those using the DN4 scale.

Most studies had low to moderate risk of bias, with small sample sizes and inconsistent reporting of injury characteristics being the main limitations. Additional limitations include heterogeneity across classification systems, limited data on the subacute phase of SCI, and variable follow-up durations.

“Despite challenges with study heterogeneity and methodological differences, our findings highlight the need for standardized diagnostic tools and early interventions to improve quality of life,” the study authors concluded.