Cellular therapies for treating pain associated with spinal cord injury
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Cellular therapies for treating pain associated with spinal cord injury Lawrence Leung1,2,3
Abstract Spinal cord injury leads to immense disability and loss of quality of life in human with no satisfactory clinical cure. Cell-based or cell-related therapies have emerged as promising therapeutic potentials both in regeneration of spinal cord and mitigation of neuropathic pain due to spinal cord injury. This article reviews the various options and their latest developments with an update on their therapeutic potentials and clinical trialing. Keywords: Cellular therapies, Spinal cord injury, Pain
Spinal cord injury-demography and economic impact Causes of spinal cord injury (SCI) include falls, motor vehicle accidents, community violence, sports injury and work-related injuries. Annual incidence rate of SCI ranges from 15 to 40 per million [1] with an average age of onset at under 30. There is male sex predominance over female of up to 5:1, with cervical and thoracic regions being the commonest region of trauma [2-5]. Depending on the severity and level(s) of lesion, spinal cord injury leads to a combination of loss of sensory, motor and autonomic functions, translating to clinical scenarios of paraplegia, tetraplegia, aphagia, incontinence and neuropathic pain. This plethora of sequelae leads to catastrophic loss of quality of life of these young and otherwise healthy patients. Economically it also translates to immense economic costs due to loss of work productivity and the demand of life-long supportive care. It has been estimated that annual costs of health care (including hospitalisation and rehabilitation) for an average patient with spinal cord injury range from US$21,450 in Veterans Health Facilities [6] to US$88,585 in a community base setting [7]. Neuropathic pain after spinal cord injury About 65-85% of patients will suffer from pain after spinal cord injury and amongst them, 1/3 will have Correspondence: [email protected] 1 Centre of Neurosciences Study, Queen’s University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada Full list of author information is available at the end of the article
severe pain [8]. Those who experience pain for longer than 6 months are likely to continue for the next 3 to 5 years [9], with a propensity to worsen over time with other associated symptoms like fatigue, weakness and memory loss [10]. The type of pain experienced after spinal cord injury can be classified as neuropathic, musculoskeletal, visceral and others [11]. In a longitudinal sample of 100 patients followed up to 26 weeks after traumatic spinal cord injury, 40% of them reported musculoskeletal pain, 36% reported neuropathic pain at the level of lesion and 16% reported neuropathic pain below level of lesion [12]. Neuropathic pain is more common with incomplete lesions of the cord and is more often associated with cervical as compared to other levels of injury [12]. Like other types of neuropathic pain, pain due to spinal cord injury remains as a major challenge in pain management and so far t
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