Opstacles in neuropathic pain treatment in the developing country: Neuropathic pain treatment

Abstract

Introduction: Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the peripheral or central nervous system. The central neuropathic pain includes thalamic pain syndrome, pain related to multiple sclerosis, poststroke pain, post spinal cord injury pain. Almost 60% of patients with spinal cord injuries have neuropathic pain whose treatment requires great socioeconomic support for a long time. Case Report: Male, 56 years old, previously healthy, was examined at the Outpatient pain Clinic, Clinical Centre of Serbia. He complained about a strong pain in both legs and a sense of tightening around the trunk. The pain was present on rest and getting worse on mobilization, intensity 7-10/10 by NRS. In 2008. after falling into the shallow water, he sustained comminuted C7 fracture resulting in quadriplegia. He was operated and regained motor skills in both arms with some residual sensory deficits. Detailed neurological examination diagnosed the presence of neuropathic pain in the trunk (T4-L1 dermatome being the worst pain with hyperalgesia, dysesthesia, hyperpathia), with sensitivity fairly preserved. Regarding therapy, only fentanyl patches helped with the dose increase but tightening sense persisted. Combined lidocaine and ketamine infusion was applied - the response was temporarily good. The patient still feels pain and uses fentanyl patches, baclofen and physical therapy. Discussion: Treatment of neuropathic pain represents a great socioeconomic problem even for developed countries because there is no benefit of conventional pharmacologic therapy in long-term use. Also, neuromodulatory therapy methods provide the most benefits for this group of patients but demand trained personnel and use of expensive equipment. Conclusion: This case is a good example of difficulties regarding treatment of this type of chronic pain in a developing country: limits of pharmacotherapy, no trained doctors for implantation of neuromodulatory devices, high price of neuromodulatory devices.

Keywords

• neuropathic pain
• quadriplegia
• dermatome
• sensory deficit