The need for research

Neuropathic pain is a debilitating condition which affects approximately half of people with SCI, and to date has no cure. People with neuropathic pain following spinal cord injury often describe it as worse than the injury itself. CNP persistently interferes with day-to-day living, affecting peoples’ sleep, mental health and wellbeing, as well as their ability to work, study or maintain any kind of social or family life. Once it develops it remains for life, and often does not respond to treatment, hence the need to find therapeutic options for people living with this condition.

SMSR-funded studies

Cingulotomy for refractory neuropathic pain following spinal cord injury (CRNP-SCI)

Led by St Georges Hospital NHS Trust

Led by St George's Hospital London, and involving the NSIC Stoke Mandeville, and the London Spinal Cord Injury Centre Stanmore, researchers will embark on a three-year project to explore the effectiveness of a procedure called cingulotomy, a minimally invasive surgical intervention that is able to locate and target a specific region of the brain with pinpoint accuracy, to help hinder overactive nerve pathways which regulate chronic pain in SCI individuals.

Commenting on being awarded funding for the project, Mr Erlick Pereira, Consultant Neurosurgeon at St George's University Hospital and lead researcher for the project, said: “Neuropathic pain is very common following spinal cord injury, with significant long-term impact on an individual’s quality of life, functional ability and mental health, as well as increased utilisation of health care resources. For some patients, this condition is resistant to existing treatments for CNP and has a devastating effect on their lives and the lives of their families. We are grateful to Spinal Research and Stoke Mandeville Spinal Research for the pledge to fund this project over the next three years, and hope that the research will identify cingulotomy as a safe and effective option for patients and provide them with relief.”

Update May 2023: Recruitment has been slower than expected due to the ethical requirement to exhaust all other treatment options before offering the procedure - most patients have not yet tried less risky procedures such as Spinal Cord Stimulation (SCS). The research design has been amended to include a control group of SCS patients and there is an emphasis on investigating SCS in these patients to make the data more robust. The researchers are studying various markers in patients undergoing SCS treatment for pain, including those with SCI, in keeping with the study’s original aims to improve neurosurgery for pain in SCI. The goal is still to recruit 6 cingulotomy patients with SCI and explore its effects on neuropathic pain.

This project is jointly funded by SMSR and Spinal Research and is expected to complete in April 2025.

Electroencephalograph predictors of central neuropathic pain in subacute spinal cord injury

Led by the University of Glasgow

This study will use electroencephalograph (EEG) prediction techniques to determine whether a newly injured person with spinal cord injury (SCI) is likely to go on to suffer from central neuropathic pain (CNP). 

Led by the University of Glasgow, and involving patients at the National Spinal Injuries Centre (NSIC), Stoke Mandeville, and the National Spinal Injuries Unit (NSIU), Glasgow, this two-year collaborative study hopes to be able to identify those patients who will go on to develop chronic neuropathic pain in the future and facilitate the development of preventative treatment as a result. 

The study will focus on how brain activity related to CNP in people with SCI develops over time and will use EEG to measure this activity as early as possible following their injury, before they start to develop neuropathic pain, which is believed to be a consequence of a gradual build-up of hyperexcitability in the nerves, eventually leading to this debilitating condition. 

Lead researcher at the University of Glasgow, Dr Aleksandra Vuckovic, said: “Neuropathic pain is extremely hard to treat. We propose to define predictive markers of central neuropathic pain (CNP) based on related brain activity accurately measured by electroencephalograph (EEG). Early EEG markers of pain will be used to create a machine learning system used to identify the risks to each newly injured patient enabling us to recommend effective preventive treatment. We will record EEG in more than 60 people across two spinal units in Scotland and England early after their spinal cord injuries and analyse brain activity of those who have and have not developed pain within the first six months. With this data, we create a 'machine learning algorithm' able to predict the risks of any patient in the future developing CNP. This will provide clinicians with the ability to better prescribe preventive treatments.”

Update May 23: The study is now complete, and 26 patients were recruited at Stoke Mandeville. The team are writing up the results and preparing to present at the ISCoS conference in October.

This project is jointly funded by SMSR and Spinal Research.