Relationship between the interval before high-dose methylprednisolone administration and chronic pain in traumatic spinal cord injury

OBJECTIVE: To examine the relationship between the interval before the administration of high-dose methylprednisolone (MP) and pain in traumatic spinal cord injury (SCI) patients.

METHODS: We retrospectively studied the medical records of admitted patients with traumatic SCI at the Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan from January2005 to January 2010. We examined the relationship between the interval before the administration of highdoseMP, and the severity of pain and the presence of neuropathic pain (NeP). Patients treated with highdoseMP <8 hours after their injuries were defined as the classical-MP group (n=22), and patients who received high-dose MP >/-8 hours after their injuries were defined as the delayed-MP group (n=10). The patients were mailed questionnaires including the Short-Form McGill Pain Questionnaire (SF-MPQ), and the Douleur Neuropathique 4 Questions questionnaire (DN4Q).

RESULTS: The SF-MPQ score in the classical-MP group(9.54 +/- 10.4) was almost 2-fold more than in the delayed-MP group (5.9 +/- 3.5). The interval before the administration of high-dose MP was positively correlated with the DN4Q and SF-MPQ scores, although these differences, and associations were not statistically significant. The increased interval in the administration of MP resulted in slightly greater pain and an increased prevalence of NeP.

CONCLUSION: Although the delayed administration of high-dose MP did not significantly increase the severity of pain or prevalence of NeP, it should still be avoided due to the increased risk of serious side effects.