SEVERE TACTILE ALLODYNIA FOLLOWING SPINAL CORD INJURY: A CHALLENGING CASE OF NEUROPATHIC PAIN MANAGEMENT

Abstract

Background: Pain management in spinal cord injury (SCI) patients remains a significant clinical challenge, particularly in cases of neuropathic pain and severe tactile allodynia. Despite adherence to standard treatment guidelines, many patients experience inadequate pain relief, leading to reduced quality of life. Tactile allodynia, an exaggerated pain response to non-painful stimuli, is a rare but debilitating manifestation of SCI-related neuropathic pain. Effective management requires a multimodal approach, integrating pharmacological and non-pharmacological interventions. Case Presentation: We present a case of a 52-year-old female with central cord syndrome following a cervical SCI caused by a road traffic accident. Despite surgical decompression and stabilization, she developed severe neuropathic pain characterized by burning sensations and profound tactile allodynia at the injury level. Initial pharmacological treatment with pregabalin and amitriptyline provided minimal relief. Due to persistent pain, the patient was hospitalized and managed with a multimodal approach, including gabapentin, tramadol, baclofen, cognitive behavioral therapy (CBT), and transcutaneous electrical nerve stimulation (TENS). This combination led to significant pain reduction, allowing discharge with an acceptable pain level. Conclusion: This case highlights the complexity of managing severe tactile allodynia in SCI patients. A tailored multimodal treatment approach combining pharmacological therapy with CBT and TENS proved effective in achieving substantial pain relief. Future studies should explore individualized treatment strategies to improve outcomes for patients with refractory SCI-related neuropathic pain.