Introducing the International Spinal Cord Injury Pain (ISCIP) Classification

An analog of phenelzine demonstrates effective acrolein scavenging and neuroprotection without monoamine oxidase inhibition in a rat SCI model

Oxidative stress is widely recognized as a critical factor in the functional deficits after spinal cord injury (SCI). Oxidative stress and lipid peroxidation-derived aldehydes such as acrolein are known to play a key role in SCI pathology and have therefore emerged as valuable therapeutic targets. This study introduces a novel phenelzine analogue (PhzA), designed to retain the acrolein scavenging capability of phenelzine (Phz) while removing its undesirable monoamine oxidase (MAO) inhibition effects through structure-based modification. Using a rat model of contusion SCI, we showed that PhzA significantly reduced acrolein levels in both the acute and chronic stages of SCI with minimal MAO inhibition. In addition, PhzA reduced excessive microglial and astrocytic activation, dampening inflammation and gliosis. Furthermore, PhzA-treated rats exhibited significant improvements in motor function and reduction in mechanical hypersensitivity for up to 28 days post-injury compared to untreated rats. These findings further underscore the crucial role of aldehydes in SCI pathology and strengthen the notion that acrolein could serve as an effective therapeutic target for mitigating post-SCI neurodegeneration. These results also indicate that the expansion of acrolein-scavenging drug discovery through structure-based modification of existing repurposed drugs, such as with Phz, is a viable strategy with the benefit of a likely accelerated path towards clinical application. This effort may also benefit a range of neuronal diseases and injuries beyond SCI where acrolein is implicated, advancing the health of millions of patients.

The Nottwil Standard-Development and Implementation of an International Classification of Functioning, Disability and Health-Based Clinical Standard Assessment for Post-acute Rehabilitation After Newly Acquired Spinal Cord Injury

Introduction: Assessments during rehabilitation of spinal cord injury (SCI) align with the World Health Organization's classifications and national quality requirements. This paper aims to report on the development and first implementation experiences of an institutional standard of assessments performed after newly acquired SCI.

Setting: Specialized SCI acute care and post-acute rehabilitation clinic in Switzerland.

Methods: A situation analysis of an interdisciplinary post-acute SCI rehabilitation program was performed. The results informed a subsequent consensus-based selection of assessments, and an information and implementation strategy. Linking to the ICF Core Set for SCI in post-acute settings and ICF Generic-30 Set was performed. The Nottwil Standard was piloted for 18 months.

Results: Situation analysis: A battery of 41 assessments were irregularly performed during initial rehabilitation after newly aquired SCI. Selection of assessments: A multidisciplinary group of clinicians agreed on 10 examinations, 23 assessments and two questionnaires that make up the Nottwil Standard. In total, 55 ICF categories are covered, including most of the ICF Generic-30 Set categories. The implementation strategy included Executive Board commitment, a structured improvement project, guidelines for documentation and assessments, a manual controlling system, and staff training on the Nottwil Standard. Pilot phase: 54 persons with paraplegia and 42 with tetraplegia (75 male; 21 female) were included. Twenty-seven assessments out of 33 assessments were performed in more than 80% of all observed patients' rehabilitation.

Conclusion: Implementation of a standard assessment schedule was feasible but required a well-structured process with good communication strategy and controlling mechanism, and full engagement of involved professions.

Treatments that are perceived to be helpful for non-neuropathic pain after traumatic spinal cord injury: a multicenter cross-sectional survey

STUDY DESIGN

Cross-sectional survey.

OBJECTIVES

The objective of the study was to identify the treatments that people with traumatic spinal cord injury (SCI) used for their non-neuropathic pains (nonNeuPs) and how they subjectively rated the helpfulness of those treatments.

SETTING

Six centers from the Spinal Cord Injury Model Systems.

METHODS

Three hundred ninety one individuals who were at least 1-year post-traumatic SCI were enrolled. A telephone survey was conducted for pharmacologic and non-pharmacologic treatments utilized in the last 12 months for each participant's three worst pains and the perceived helpfulness of each treatment for each pain.

RESULTS

One hundred ninety (49%) participants reported at least one nonNeuP (Spinal Cord Injury Pain Instrument score < 2) in the previous 7 days. NSAIDs/aspirin, acetaminophen, opioids, and cannabinoids were the most commonly used and helpful pharmacologic treatments for overall nonNeuP locations (helpful in 77-89% of treated pains). Body position adjustment, passive exercise, massage, resistive exercise, and heat therapy were reported as the most commonly used non-pharmacological treatments for nonNeuPs. Heat therapy, aerobic exercise, massage, and body position adjustment were the most helpful non-pharmacological treatments for overall nonNeuP locations (helpful in 71-80% of treated pains). Perceived helpfulness of treatments varied by pain locations, which may be due to different mechanisms underlying pains in different locations.

CONCLUSIONS

Results of the study may help guide clinicians in selecting pain-specific treatments for nonNeuPs. The self-reported helpfulness of heat therapy, exercise, and massage suggests a possible direction for clinical trials investigating these treatments of nonNeuP while limiting the side effects accompanying pharmacologic treatments.