NeuroRehabilitation - Volume 47, issue 3

Authors: Zasler, Nathan D.

Article Type: Editorial

DOI: 10.3233/NRE-208000

Citation: NeuroRehabilitation, vol. 47, no. 3, pp. 251-252, 2020

Authors: Kessler, Allison | Yoo, Min | Calisoff, Randy

Article Type: Review Article

Abstract: Complex regional pain syndrome (CRPS) is a complex disorder that can have a significant impact on the quality of life of a person with this syndrome. The diagnosis and treatment of CRPS are often difficult as there is no one confirmatory test and no one definitive treatment. Currently, the most widely accepted clinical diagnostic criteria are the Budapest criteria, which were developed by expert consensus. Though no one single treatment has been found to be universally effective, early detection and an interdisciplinary approach to treatment appear to be key in treating CRPS. This review aims to present up-to-date clinical information …regarding the diagnosis and management of CRPS and highlight the potential issues with diagnosis in the neurological population. Ultimately, more research is needed to identify the exact etiology of CRPS in order to help target appropriate therapies. In addition, more randomized controlled trials need to be performed in order to test new therapies or combinations of therapies, including pharmacological, interventional, and behavioral therapies, to determine the best treatment options for this potentially debilitating disorder. Show more

Keywords: Complex regional pain syndrome, CRPS, reflex sympathetic dystrophy, RSD, pain

DOI: 10.3233/NRE-208001

Citation: NeuroRehabilitation, vol. 47, no. 3, pp. 253-264, 2020

Authors: Murphy, Douglas | Lester, Denise | Clay Smither, F. | Balakhanlou, Ellie

Article Type: Research Article

Abstract: Neuropathic pain (NP) can have either central nervous system causes or ones from the peripheral nervous system. This article will focus on the epidemiology, classifications, pathology, non-invasive treatments and invasive treatments as a general review of NP involving the peripheral nervous system. NP has characteristic symptomatology such as burning and electrical sensations. It occurs in up to 10% of the general population. Its frequency can be attributed to its occurrence in neck and back pain, diabetes and patients receiving chemotherapy. There are a wide range of pharmacologic options to control this type of pain and when such measures fail, numerous …interventional methods can be employed such as nerve blocks and implanted stimulators. NP has a cost to the patient and society in terms of emotional consequences, quality of life, lost wages and the cost of assistance from the medical system and thus deserves serious consideration for prevention, treatment and control. Show more

Keywords: Neuropathy, polyneuropathy, neuropathic pain, nerve blocks, anticonvulsants, SSRIs, burning pain, hyperalgesia

DOI: 10.3233/NRE-208002

Citation: NeuroRehabilitation, vol. 47, no. 3, pp. 265-283, 2020

Authors: Hassaballa, Deena | Harvey, Richard L.

Article Type: Research Article

Abstract: The management of pain in persons with neurological injuries is challenging and complex. A holistic view and clinical approach are necessary when addressing pain in patients with neurological impairment because interpreting signs and symptoms and deciphering sources of pain is never a straightforward process. This problem is further magnified with the management of central pain syndromes. The best approach is to have a good understanding of the clinical characteristics commonly found in this patient population, in particular for patients with stroke, multiple sclerosis (MS), or spinal cord injury (SCI), as central pain manifests differently between these groups. This paper will …focus on the history, clinical presentation, pathophysiology, assessment, and treatment of central pain in patients with these types of neurological conditions. In addition to being at risk for a decline in quality of life, patients with pain syndromes are also prone to adverse responses to treatments (e.g., opioid addiction). It is therefore important to methodically analyze the similarities and differences between patients with different pain syndromes. Show more

Keywords: Central pain, central post stroke pain, multiple sclerosis pain, spinal cord injury pain, neuropathy

DOI: 10.3233/NRE-208003

Citation: NeuroRehabilitation, vol. 47, no. 3, pp. 285-297, 2020

Authors: Katta-Charles, Sheryl D.

Article Type: Research Article

Abstract: While non-headache, non-oral craniofacial neuralgia is relatively rare in incidence and prevalence, it can result in debilitating pain. Understanding the relevant anatomy of peripheral branches of nerves, natural history, clinical presentation, and management strategies will help the clinician better diagnose and treat craniofacial neuralgias. This article will review the nerves responsible for neuropathic pain in periorbital, periauricular, and occipital regions, distinct from idiopathic trigeminal neuralgia. The infratrochlear, supratrochlear, supraorbital, lacrimal, and infraorbital nerves mediate periorbital neuralgia. Periauricular neuralgia may involve the auriculotemporal nerve, the great auricular nerve, and the nervus intermedius. The greater occipital nerve, lesser occipital nerve, and third …occipital nerve transmit occipital neuralgias. A wide range of treatment options exist, from modalities to surgery, and the evidence behind each is reviewed. Show more

Keywords: Craniofacial neuralgia, glossopharyngeal neuralgia, trigeminal neuralgia, great auricular nerve, lesser occipital nerve, third occipital nerve, occipital neuralgia

DOI: 10.3233/NRE-208004

Citation: NeuroRehabilitation, vol. 47, no. 3, pp. 299-314, 2020

Authors: Stover, Gary | Prahlow, Nathan

Article Type: Review Article

Abstract: Acquired limb loss, whether from accident or amputation, occurs with an incidence of greater than 175,000 per year in the United States. Current prevalence is estimated at greater than 1.5 million and is expected to double within 30 years. While many patients with amputations may have no significant pain or sensory issues after healing from the initial loss, one-quarter to one-half of patients may have ongoing difficulties with residual limb pain, phantom limb pain, or phantom limb sensation. This review explores the potential etiologies of those symptoms, as well as a variety of treatment options that a practitioner may consider …when approaching this condition. Show more

Keywords: Amputation, residual limb pain, stump pain, phantom limb pain

DOI: 10.3233/NRE-208005

Citation: NeuroRehabilitation, vol. 47, no. 3, pp. 315-325, 2020

Authors: Dwyer, Brigid | Zasler, Nathan

Article Type: Research Article

Abstract: After traumatic brain injury (TBI), a host of symptoms of varying severity and associated functional impairment may occur. One of the most commonly encountered and challenging to treat are the post-traumatic cephalalgias. Post-traumatic cephalalgia (PTC) or headache is often conceptualized as a single entity as currently classified using the ICHD-3. Yet, the terminology applicable to the major primary, non-traumatic, headache disorders such as migraine, tension headache, and cervicogenic headache are often used to specify the specific type of headache the patients experiences seemingly disparate from the unitary definition of post-traumatic headache adopted by ICHD-3. More complex post-traumatic presentations attributable to …brain injury as well as other headache conditions are important to consider as well as other causes such as medication overuse headache and medication induced headache. Treatment of any post-traumatic cephalalgia must be optimized by understanding that there may be more than one headache pain generator, that comorbid traumatic problems may contribute to the pain presentation and that pre-existing conditions could impact both symptom complaint, clinical presentation and recovery. Any treatment for PTC must harmonize with ongoing medical and psychosocial aspects of recovery. Show more

Keywords: Post-traumatic headache, post-traumatic cephalalgia, headache disorders, traumatic brain injury, cervical whiplash injury, cervicalgia

DOI: 10.3233/NRE-208006

Citation: NeuroRehabilitation, vol. 47, no. 3, pp. 327-342, 2020

Authors: Popkirov, Stoyan | Enax-Krumova, Elena K. | Mainka, Tina | Hoheisel, Matthias | Hausteiner-Wiehle, Constanze

Article Type: Review Article

Abstract: BACKGROUND: Nociplastic pain has been recently introduced as a third mechanistic descriptor of pain arising primarily from alterations of neural processing, in contrast to pain due to tissue damage leading to nociceptor activation (nociceptive) or due to lesion or disease of the somatosensory nervous system (neuropathic). It is characterized by hyperalgesia and allodynia, inconsistency and reversibility, as well as dynamic cross-system interactions with biological and psychobehavioral factors. Along with this renewed understanding, functional pain disorders, also classified as chronic primary pain, are being reframed as biopsychosocial conditions that benefit from multimodal treatment. OBJECTIVE: To summarize the current understanding …of nociplastic pain and functional pain disorders, with a focus on conditions that are common in neurology practice. METHODS: This was a narrative literature review. RESULTS: Chronic back pain, fibromyalgia syndrome and complex regional pain syndrome are best understood within a biopsychosocial framework of pain perception that considers structural factors (predispositions and sequelae) and psychobehavioral mechanisms. Although pain is often the primary complaint, it should not be the only focus of treatment, as accompanying symptoms such as sleep or mood problems can significantly impact quality of life and offer useful leverage points for multimodal treatment. Analgesic pharmacotherapy is rarely helpful on its own, and should always be imbedded in a multidisciplinary setting. Show more

Keywords: Nociplastic, chronic pain, psychogenic, back pain, complex regional pain syndrome, CRPS, fibromyalgia

DOI: 10.3233/NRE-208007

Citation: NeuroRehabilitation, vol. 47, no. 3, pp. 343-353, 2020

Authors: Hazelton, Christine

Article Type: Other

Abstract: BACKGROUND: Disorders of attention are common following stroke, reducing quality of life and limiting rehabilitation. OBJECTIVE: To determine if cognitive rehabilitation can improve attention and functional outcomes in stroke survivors with attentional disorders. METHODS: A summary of the Cochrane Review update by Loetscher et al. 2019 , with comments. RESULTS: Six studies with 223 participants were included: this was the same as the previous review (in 2013). Evidence quality was very low to moderate, and results suggest a beneficial impact on divided attention immediately after training, but no effect on any other outcome either …immediately or at follow up timepoints. CONCLUSIONS: The low methodological quality and small number of studies means current evidence provides limited clinical guidance. Clearly more research is needed to inform care: researchers must improve the methodological quality of studies, plus fully consider and report the aspects of attention and function addressed in their work. Show more

Keywords: Stroke, attention, intervention, cognitive rehabilitation, review

DOI: 10.3233/NRE-209007

Citation: NeuroRehabilitation, vol. 47, no. 3, pp. 355-357, 2020