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Cold hyperesthesia and chronic pain after pediatric-onset spinal cord injury: an exploratory cross-sectional study
Marta Ríos-León1,2,3, Beatriz Huidobro-Labarga4, Inmaculada Castillo-Aguilar5
1Sensorimotor Function Group, Hospital Nacional de Parapléjicos (SESCAM), Toledo, Spain.
Insights
Sensory testing in pediatric spinal cord injury (SCI) reveals distinct pain patterns. Cold sensitivity above the injury suggests neuropathic pain, while below indicates nociceptive pain, aiding in understanding SCI pain subtypes.
Area of Science:
- Neurology
- Pain Medicine
- Pediatric Rehabilitation
Background:
- Spinal cord injury (SCI) in children can lead to complex pain syndromes.
- Characterizing sensory changes is crucial for understanding neuropathic and nociceptive pain subtypes.
- Paediatric-onset SCI presents unique challenges in pain assessment and management.
Purpose of the Study:
- To characterize the sensory signs of nociceptive and neuropathic pain in a paediatric-onset SCI cohort.
- To differentiate sensory profiles associated with mixed pain subtypes.
- To investigate sensory changes above, at, and below the level of SCI.
Main Methods:
- Exploratory, cross-sectional observational study at a specialized SCI rehabilitation hospital.
- Involved 51 individuals with paediatric-onset SCI (mean age 12.8 years).
- Utilized standardized bedside testing (BST) and quantitative sensory testing (QST), including a novel dynamic QST method for cold hyperaesthesia.
Main Results:
- No significant sensory differences were found at or below SCI, except for hypoaesthesia to light touch in nociceptive pain.
- Dynamic QST identified increased cold intensity above SCI, indicative of probable neuropathic pain (NP).
- Standardized QST showed elevated cold pain thresholds at and below SCI, typical of nociceptive pain.
Conclusions:
- Sensory function changes throughout the neuroaxis after paediatric SCI, indicating widespread pathophysiological mechanisms.
- Understanding cold hyperaesthesia and pain subtypes is vital for improving paediatric SCI pain prognosis.
- Further research with larger cohorts is needed to confirm findings and refine treatment strategies.
Objective:
To characterize the sensory signs of nociceptive, neuropathic, and mixed pain (NP) subtypes, in a pediatric-onset spinal cord injury (SCI) cohort.
Design:
Exploratory cross-sectional observational study.
Setting:
Monographic SCI Rehabilitation Hospital.
Subjects:
Fifty-one individuals (12.8 ± 3.4 years; 52.9% females) with pediatric-onset SCI (8.1 ± 4.8 years).
Methods:
Standardized bedside and quantitative sensory testing (BST/QST), and a novel dynamic QST method to test cold hyperesthesia above, at, and below the SCI.
Results:
BST performed to evaluate differences in sensory function at or below the level of SCI revealed no differences with dynamic light touch (Brush), pinprick, cold, or heat thermoroller stimuli, except for hypoesthesia to dynamic light touch (Q-tip) in youth with nociceptive pain. Dynamic QST assessment detected a high level of perceived tonic cold intensity above the level of SCI that was characteristic of probable NP, whereas standardized QST identified elevated at- and below-level cold pain thresholds that were typical of nociceptive pain. In the nociceptive pain cohort, SCI evolution time correlated positively with both at-level and above-level tonic cold intensity. Finally, in youth with nociceptive pain, at-level tonic cold intensity correlated with below-level tonic cold intensity.
Conclusions:
Assessment of change in cold sensory function, above, at, or below the SCI, highlights the presence of pathophysiological mechanisms throughout the neuroaxis after SCI in the pediatric cohort. Further understanding of cold hyperesthesia with chronic nociceptive and neuropathic pain subtypes, in a larger statistically powered confirmatory study, may lead to an improved prognosis of SCI pain in the pediatric population.
