Will I experience permanent pain from the scar in my thoracic spinal cord?

Management of Pain Following Thoracic Spinal Cord Lesion

Your pain is likely neuropathic in nature and can be effectively managed with appropriate treatment, though complete resolution may not be possible in all cases.

Understanding Your Condition

Your symptoms suggest neuropathic pain resulting from the T6 spinal cord lesion identified on MRI. The progression from intermittent pain and numbness in both legs to whole-body pain following steroid treatment is consistent with central neuropathic pain syndrome after spinal cord injury.

The 11 x 7 mm T2 lesion in your thoracic spinal cord represents tissue damage that has likely resulted in scarring, which is now causing your pain symptoms 1, 2.

Pain Characteristics and Prognosis

Neuropathic pain following spinal cord injury:

• Affects approximately 65% of individuals with spinal cord injuries 3
• Often presents as burning, shooting, or electrical sensations
• Can develop in areas below, at, or even above the level of injury
• May persist long-term, with studies showing pain continuing 13+ years after injury 3

Treatment Approach

First-Line Medication

• Pregabalin (Lyrica) is the most appropriate first-line medication for your condition 4
  • Starting dose: 150 mg/day divided into 2-3 doses
  • Can be titrated up to 300-600 mg/day as needed and tolerated
  • Clinical trials show significant pain reduction in spinal cord injury patients
  • Some patients experience improvement as early as week 1 of treatment 4

Alternative Medications if Pregabalin is Ineffective

1. Gabapentin (similar mechanism to pregabalin)
2. Tricyclic antidepressants (amitriptyline, nortriptyline)
3. SNRIs (duloxetine, venlafaxine)
4. Tramadol or other pain medications for breakthrough pain

Non-Pharmacological Approaches

• Physical therapy focusing on active exercises rather than passive therapy 2
• Land-based physical therapy is recommended over aquatic therapy 2
• Cognitive behavioral therapy for pain management

Monitoring and Follow-up

• Evaluate treatment response after 2-4 weeks of medication therapy 2
• If insufficient response, consider medication adjustment or rotation 2
• Regular follow-up with validated pain assessment tools to track progress

Important Considerations

• Avoid unnecessary imaging: Repeated MRIs are not recommended unless there is clinical deterioration 1, 2
• Realistic expectations: While significant improvement is possible, complete pain resolution may not be achievable in all cases 5
• Long-term management: Neuropathic pain from spinal cord injury often requires ongoing treatment 6

Prognosis

The question of whether you will experience permanent pain is complex. Studies show that:

• Some patients experience significant improvement with appropriate treatment 4
• About 50-53% of patients maintain therapeutic response at 26 weeks with appropriate medication 4
• Complete resolution is less common but possible in some cases

Red Flags Requiring Immediate Medical Attention

Seek immediate medical attention if you experience:

• Progressive neurological deficits (increasing weakness, numbness)
• Bowel or bladder dysfunction
• Significant worsening of pain despite treatment

While complete resolution cannot be guaranteed, appropriate management with pregabalin and complementary therapies offers the best chance for significant pain reduction and improved quality of life.