J Korean Pain Soc.  2000 Jun;13(1):105-110.

The Treatment of Central Pain after Spinal Cord Injury

Affiliations
  • 1Department of Anesthesiology, Chungnam National University College of Medicine, Taejeon, Korea.

Abstract

Central neuropathic pain may occur in 10-20% of the patients after spinal cord injury. The central pain syndrome include spontaneous continuing and intermittent pain as well as evoked pain. The pain is evoked by non-noxious stimulation of the region (allodynia) and repeated stimulation (wind-up phenomenon). Four patients were referred suffering from severe pain, allodynia and hyperaesthesia after spinal cord injury. They had received conventional treatment with non-steroidal anti-inflammatory drugs, steroid, anticonvulsant, antidepressant and rehabilitation which failed to provide pain relief. We administered combination of low doses of morphine and ketamine (10 mg) through the epidural catheter with other conventional therapy. Satisfactory pain relief was achieved in each patient. The reduction of pain was not associated with severe side effects, The most bothersome side effect of ketamine was dizziness in one patient, only caused by bolus injection (ketamine 10 mg with normal saline 10 ml). This suggests synergy from this combination that provides an alternative treatment for central pain.

Keyword

Analgesics, continuous epidural ketamine-morphine; Pain, central pain; Spinal cord injury
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