Disclosures: Behzad S. Shojaee: No financial relationships or conflicts of interest

Case Diagnosis: A 64-year-old male with traumatic SCI (paraplegia) of 12 months duration

Case Description or Program Description: The patient with post-traumatic complete Spinal Cord Injury (Level T2) of 12 months duration was admitted to SCI/D unit for management of pressure injury. Since injury, he reported having abdominal discomfort localized around the T8-9 dermatome along the anterior abdominal wall, described as a “band like sensation” squeezing/tightening around the abdomen. The discomfort recently become more bothersome, was associated with nausea/diminished appetite, and prevented daily routines including recreational activities. It was unrelated to any form of dietary intake, timing of meals or pattern of bowel movement. Patient has a history of irritable bowel syndrome but had never experienced this discomfort before his injury.

Setting: Syracuse VA inpatient Spinal Cord Injury/Disorder unit

Assessment/Results: Evaluation to rule out abdominal pathology (due to nausea/reduced appetite), and atypical cardiac etiology included: normal lab work (Amylase/Lipase, liver function tests), and Non-contrast CT abdomen/pelvis without abnormality except for mild left-sided hydronephrosis, but no stones. Considering a possible atypical neuropathic pain presentation, Pregabalin was started. The patient responded to 50 mg twice a day dosage. He noted reduced band like discomfort, no nausea and improved appetite and was able to return to his daily routines without disturbance.

Discussion (relevance): Visceral pain below the level of injury may present differently and is primarily considered when symptoms are associated with nausea or reduced appetite. A stable neurological exam, normal abdominal exam, and negative work up for abdominal pathology led to a diagnosis of atypical neuropathic pain. Treatment and symptom resolution with Pregabalin supported this diagnosis.

Conclusions: It can be challenging to differentiate visceral pain and below level neuropathic pain due to variable presentations. Neuropathic pain below the level of injury can present with atypical symptoms, as in this case, and should be considered as a differential after carefully ruling out other potential visceral causes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-interesting-case-of-atypical-neuropathic-pain-in-a-patient-with-spinal-cord-injury-a-case-report/