Management of Pain After Transverse Thoracic Myelitis
Patients with transverse thoracic myelitis may experience long-term neuropathic pain due to spinal cord scarring, but complete recovery without pain is possible with appropriate treatment, including spinal cord stimulation when conventional therapies fail. 1, 2
Understanding Transverse Myelitis and Pain Mechanisms
Transverse myelitis (TM) is a rare neurologic disorder characterized by acute inflammation resulting in spinal cord injury. In your case:
- The T6 lesion (11 x 7 mm) identified on MRI is consistent with thoracic transverse myelitis
- The progression from intermittent to constant pain is typical of neuropathic pain development following spinal cord injury
- Whole-body pain after steroid treatment may represent central sensitization, a common complication of myelitis
Pain Prognosis
The pain you're experiencing may be due to:
- Spinal cord scarring (gliosis) at the T6 level
- Neuronal hyperexcitability in damaged pathways
- Central sensitization of pain processing
Treatment Approach
First-Line Therapies
- Neuropathic pain medications: Your doctor's prescription of nerve pain medication is appropriate as first-line therapy 1
- Typically includes gabapentinoids (gabapentin, pregabalin)
- Tricyclic antidepressants (amitriptyline, nortriptyline)
- Serotonin-norepinephrine reuptake inhibitors (duloxetine, venlafaxine)
Second-Line Approaches
- Physical therapy focusing on:
- Maintaining mobility
- Preventing complications
- Functional improvement
- Cognitive behavioral therapy for pain management
Advanced Interventions
- Spinal cord stimulation (SCS) has shown significant efficacy for refractory neuropathic pain following transverse myelitis 2, 3, 4
- Case reports demonstrate 70-80% pain reduction with SCS
- Improvements in function and quality of life
- Reduced medication requirements
Recovery Potential
The American College of Radiology guidelines indicate that:
- Complete or partial recovery is possible in transverse myelitis 1
- Natural healing processes can occur over time
- Recovery timeline varies significantly between patients
Important Considerations
- Timing matters: Most neurological recovery occurs within the first 3-6 months, but improvements can continue for up to 2 years
- Red flags requiring immediate medical attention:
- New or worsening weakness
- Bladder/bowel dysfunction
- Sensory level changes
- Signs of infection
Follow-up Recommendations
- Regular neurological assessments to monitor recovery
- MRI follow-up to evaluate lesion evolution
- Adjustment of pain management strategy based on response
- Consider referral to a specialized neurorehabilitation center
If conventional pain management fails after 3-6 months, spinal cord stimulation should be considered as it has demonstrated significant efficacy specifically for neuropathic pain following transverse myelitis 2, 3, 4.