Ann Rehabil Med.  2013 Oct;37(5):721-724. 10.5535/arm.2013.37.5.721.

Intractable Abdominal Pain in a Patient With Spinal Cord Injury: A Case Report

• Park HK
• Song DH
• Kim YM
• Kim HG
• Kim SY
• Chung ME

• KMID: 2266592
• DOI: http://doi.org/10.5535/arm.2013.37.5.721

Abstract

Patients with spinal cord injury (SCI) may experience several types of chronic pains. Abdominal pain in patients with SCI has gained limited attention and little is yet known about its characteristics and mechanisms. It often has been regarded as visceral pain associated with constipation and distention. Neuropathic pains localized in the abdomen have rarely been reported. We experience a case of intractable abdominal pain in a patient with SCI, neither of visceral pathology nor of musculoskeletal origin. The nature of pain fulfilled the diagnostic criteria for neuropathic pains. The pain was therefore regarded as neuropathic and managed accordingly. The first- and second-line oral drugs available were being performed, unfortunately, adequate pain control was not achieved. We tried an intrathecal lidocaine injection as another treatment option, and the injection had considerable effects.

Keyword

Abdominal pain; Neuropathic pain; Spinal cord injuries

MeSH Terms

Abdomen
Abdominal Pain*
Chronic Pain
Constipation
Humans
Lidocaine
Neuralgia
Spinal Cord Injuries*
Spinal Cord*
Visceral Pain
Lidocaine

Figure

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  Fig. 1 Computerized tomography on abdomen showed a mild nonspecific gallbladder wall thickening.

Reference

1. Calmels P, Mick G, Perrouin-Verbe B, Ventura M. SOFMER (French Society for Physical Medicine and Rehabilitation). Neuropathic pain in spinal cord injury: identification, classification, evaluation. Ann Phys Rehabil Med. 2009; 52:83–102. PMID: 19909700.

2. Finnerup NB, Faaborg P, Krogh K, Jensen TS. Abdominal pain in long-term spinal cord injury. Spinal Cord. 2008; 46:198–203. PMID: 17621311.

3. Ebert E. Gastrointestinal involvement in spinal cord injury: a clinical perspective. J Gastrointestin Liver Dis. 2012; 21:75–82. PMID: 22457863.

4. Siddall PJ, Middleton JW. A proposed algorithm for the management of pain following spinal cord injury. Spinal Cord. 2006; 44:67–77. PMID: 16116488.

5. Celik EC, Erhan B, Lakse E. The clinical characteristics of neuropathic pain in patients with spinal cord injury. Spinal Cord. 2012; 50:585–589. PMID: 22430511.

6. Siddall PJ. Management of neuropathic pain following spinal cord injury: now and in the future. Spinal Cord. 2009; 47:352–359. PMID: 19002150.

7. Stone JM, Nino-Murcia M, Wolfe VA, Perkash I. Chronic gastrointestinal problems in spinal cord injury patients: a prospective analysis. Am J Gastroenterol. 1990; 85:1114–1119. PMID: 2389723.

8. Neumayer LA, Bull DA, Mohr JD, Putnam CW. The acutely affected abdomen in paraplegic spinal cord injury patients. Ann Surg. 1990; 212:561–566. PMID: 2241311.

9. Finnerup NB, Biering-Sorensen F, Johannesen IL, Terkelsen AJ, Juhl GI, Kristensen AD, et al. Intravenous lidocaine relieves spinal cord injury pain: a randomized controlled trial. Anesthesiology. 2005; 102:1023–1030. PMID: 15851891.

10. Siddall PJ, Molloy AR, Walker S, Mather LE, Rutkowski SB, Cousins MJ. The efficacy of intrathecal morphine and clonidine in the treatment of pain after spinal cord injury. Anesth Analg. 2000; 91:1493–1498. PMID: 11094007.