Spinal Cord Injury Pain

doi:10.1016/j.pmr.2014.01.002

Physical Medicine and Rehabilitation Clinics of North America

Volume 25, Issue 2, May 2014, Pages 397-410

https://doi.org/10.1016/j.pmr.2014.01.002 Get rights and content

Section snippets

Key points

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Spinal cord injury (SCI)-associated pain has a specific classification approach that assists in guiding treatment strategies.
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SCI-related pain seems to be prevalent, but there is considerable variability in the epidemiology of this condition.
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Evaluation of SCI-associated pain relies heavily on history and is supplemented by a neuromusculoskeletal examination and judicious use of laboratory and radiologic testing.
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Relatively few treatments for SCI-associated pain have been extensively studied.

Classification

Before 2000, there was no consistent approach to the classification of SCI-related chronic pain. This variability was described by Hicken and colleagues¹ during a review in 2002 in which 29 distinct schemes were described with potentially confusing and inconsistent terminology. By 2008, 3 classifications systems emerged as the leading systems based on their utility, comprehensiveness, validity, and reliability. These schemes included the Cardenas classification,² the taxonomy of the

Epidemiology

Given the classification ambiguity of chronic SCI-related pain described above, attempts at epidemiology can be problematic. Other potential confounders include oversampling because patients may have more than one pain syndrome, adequate pain description, criteria used for chronicity and severity, traumatic versus nontraumatic differentiation, and appropriate inclusion/exclusion criteria. Dijkers and colleagues⁹ executed a review consisting of 42 articles that described the epidemiology of this

Evaluation

The approach to SCI pain should commence in a manner similar to all chronic pain conditions—history, physical examination, and judicious use of diagnostic testing. Information should be obtained regarding the patient's initial SCI including date, mechanism of injury, associated injuries such as long bone and visceral trauma, description of vertebral column stabilization procedures, and comorbidities of the acute hospitalization and rehabilitation phase of injury. Descriptors should be attained

Nonpharmacologic

A generalized exercise program in the form of global strength training, cardiovascular training, or recreational physical activities has the potential to be beneficial for several SCI-related conditions (eg, spasticity, muscle atrophy, bone health), but its effect on global pain in this population has not been greatly satisfactory. Animal studies have suggested that antinociceptive behaviors can be reduced with weeks of exercise training.19, 20 Extrapolation from these experiments to the human

Summary

SCI pain is clearly a challenging pain syndrome. Each element of this review (classification, epidemiology, evaluation, and management) has demonstrated limitations. Further investigation by clinicians and researchers in both the SCI and pain communities is warranted in an effort to further delineate the nature of this problem and create more effective treatment strategies. Physiatrists are uniquely positioned to participate in this process and should engage in this endeavor whenever possible.