Gruener H, Zeilig G, Gaidukov E, et al. - Given the administration of preemptive treatment in patients experiencing central neuropathic pain (CNP) following spinal cord injury (SCI) requires screening patients with clinically relevant biomarkers that could predict CNP early after SCI, therefore, researchers investigated such biomarkers by measuring pronociceptive and for the first time, antinociceptive indices early after SCI, using a sample of 47 patients with acute SCI and 20 healthy controls. The prevalence of CNP was estimated to be 57.4%. Early, decreased at-level pain adaptation and conditioned pain modulation (CPM) magnitudes were displayed by SCI patients who ultimately developed CNP vs those who did not. At-level pain adaptation was identified as the best predictor for CNP development at 3 to 4 and 7 to 8 months, with odds ratios of 3.17 and 2.83, respectively (∼77% probability) and a cutoff value with 90% sensitivity. CNP severity at 3 to 4 and 24 months was predicted by allodynia and at-level CPM, respectively. Overall, it was concluded that decreased pain inhibition capacity precedes, and may result in CNP. At-level pain adaptation was identified as an early CNP biomarker that can enable the recognition of people at risk in order to start preemptive therapy.