https://uroweb.org/wp-content/uploads/20_Neurogenic-LUTD_LR.pdf

EAU Guidelines on Neurogenic Lower Urinary Tract Dysfunction

Chronic pain is an important problem following spinal cord injury (SCI) and is a major impediment to effective rehabilitation. The reported prevalence of chronic SCI pain is variable but averages 65% with around one third of these people rating their pain as severe. The mechanisms responsible for the presence of pain are poorly understood. However, evidence from clinical observations and the use of animal models of SCI pain suggests that a number of processes may be important. These include functional and structural plastic changes in the central nervous system following injury, with changes in receptor function and loss of normal inhibition resulting in an increased neuronal excitability. A number of specific types of SCI pain can be distinguished based on descriptors, location and response to treatment. Nociceptive pain can arise from musculoskeletal structures and viscera and neuropathic pain can arise from spinal cord and nerve damage. The role of psychological and environmental factors also needs to be considered. Accurate identification of these pain types will help in selecting appropriate treatment approaches. Current treatments employ a variety of pharmacological, surgical, physical and psychological approaches. However, evidence for many of the treatments in use is still limited. It is hoped that future research will identify effective treatment strategies that accurately target specific mechanisms.

/pdf/pain-following-spinal-cord-injury-4g9kytt0aq.pdf

Pain following spinal cord injury.

https://europeanurology.com/article/S0302-2838(15)00740-X/pdf/summary-of-european-association-of-urology-eau-guidelines-on-neuro-urology

Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology

This guideline has been prepared based on the scientific and professional information available in 2004. Users of this guideline should periodically review this material to ensure that the advice herein is consistent with current reasonable clinical practice.

Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals.

STUDY DESIGN: Prospective, randomized, double blind, placebo-controlled, crossover clinical trial. OBJECTIVES: To determine the efficacy of gabapentin in the treatment of neuropathic pain related to spinal cord injury. SUMMARY OF BACKGROUND DATA: Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Neuropathic pain associated with spinal cord injury is quite refractory, and current treatments are not effective. Gabapentin, an anticonvulsant, has become the first choice in the treatment of neuropathic pain. The place of gabapentin in the treatment of spinal cord injury-related neuropathic pain was questioned in only a few recent reports; however, they are retrospectively designed, nonstandardized, and uncontrolled studies, or involve a very small series of patients using less than optimum doses. METHODS: A total of 18-week study period included a 4-week medication/placebo titration period. This was followed by a 4-week stable dosing period when the patients continued to receive maximum tolerated doses, a 2-week washout period, then a crossover of 4 weeks of medication/placebo titration, and another 4 weeks of stable dosing period. Twenty paraplegic patients (female/male: 7/13) with complete spinal cord injury at the thoracic and lumbar level, aged between 20 and 65 years, with neuropathic pain for more than 6 months were recruited for the study. RESULTS: All patients completed the study. Gabapentin reduced the intensity as well as the frequency of pain, relieved all neuropathic pain descriptors except the itchy, sensitive, dull, and cold types, and improved the quality of life (P < 0.05). CONCLUSIONS: Gabapentin can be added to the list of first-line medications for the treatment of chronic neuropathic pain in spinal cord injury patients. It is a promising new agent and offers advantages over currently available treatments.

Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury.

Study design: Retrospective review of patient data. Objective: To present two years of experience in the use of gabapentin for the alleviation of neuropathic pain in spinal cord injury patients. Setting: Supra-regional Spinal Cord Service, Melbourne, Australia. Method: Data were retrieved from the medical records of all spinal cord injury patients prescribed gabapentin for neuropathic pain. Pain was assessed prior to and during treatment at 1, 3 and 6 months with a 10 cm visual analogue scale which ranged from 0 (‘no pain’) to 10 (‘worst pain imaginable’), or by the documentation of a verbal description of pain. Results: Seventy-six per cent of patients receiving gabapentin reported a reduction in neuropathic pain. In those patients with data at all four measurement points, the mean pretreatment score was 8.86. Following treatment with gabapentin the score dropped to 5.23, 4.59 and 4.13 at 1, 3 and 6 months, respectively. Where only a verbal description of pain was documented, the trend was that the pretreatment report of ‘unbearable’ was replaced by ‘liveable’ during treatment. Conclusion: Our experience suggests that gabapentin offers an effective therapeutic alternative for the alleviation of neuropathic pain following spinal cord injury. Controlled clinical trials are now required to confirm these observations.

/pdf/gabapentin-for-neuropathic-pain-following-spinal-cord-injury-2unuy3l632.pdf

Gabapentin for neuropathic pain following spinal cord injury.

There has been little research on pain in the acute phase of spinal cord injury (SCI) rehabilitation. This study surveyed the pain experience and management strategies in such patients. The subjects consisted of inpatients who were undergoing rehabilitation following their acute injury, and were assessed regarding the presence and type of any pain upon admission to the rehabilitation ward, and reviewed weekly during their stay. They were reassessed on reporting any new pain. Pain intensity was recorded on a Visual Analogue Scale. The maximum intensity of pain during admission was compared to that at discharge. All interventions directed at pain management were documented. Patients were reviewed one year after discharge regarding current pain experience. Almost all of the patients (n = 23; 96%) experienced pain at some stage during their inpatient rehabilitation. Overall pain intensity for those patients with pain during inpatient admission decreased by the time of discharge. At the one year review however, pain intensity tended towards that seen on admission. The reasons for pain tending to increase after discharge were not apparent. Neuropathic and Myofascial Pain Syndrome (MPS) were the most common types of pain experienced. A combination of pharmacological, interventional, physical and psychological approaches were used in pain management. At one year review, neuropathic pain remained common while MPS and orthopaedic pain had decreased. Pain is a common and significant problem for many SCI patients and is a challenge for the treating team to manage.

/pdf/a-survey-of-pain-during-rehabilitation-after-acute-spinal-1lbrk4kazw.pdf

A survey of pain during rehabilitation after acute spinal cord injury.

Collection of semen from men in acute phase of spinal cord injury

Necrospermia and chronic spinal cord injury.

The aim of this study was to develop a technique which would prevent retrograde ejaculation in chronic spinal cord injured (SCI) patients undergoing vibration and electroejaculation procedures. A balloon catheter was used to tamponade the bladder neck in 12 patients who underwent 100 assisted ejaculation procedures. Antegrade ejaculations were collected on all occasions with no incidences of urine contamination and no sperm were seen in post ejaculatory urine. Silicone catheters had minimal effects on sperm motility and viability. All lubricant gels were found to adversely affect sperm quality and were not used.

/pdf/a-simple-technique-to-prevent-retrograde-ejaculation-during-202i3ji3d4.pdf

T.C. Lim

Papers

Gabapentin for neuropathic pain following spinal cord injury.

A survey of pain during rehabilitation after acute spinal cord injury.

Collection of semen from men in acute phase of spinal cord injury

Necrospermia and chronic spinal cord injury.

A simple technique to prevent retrograde ejaculation during assisted ejaculation.