Spinal Cord Injury Update
Spring 2009: Volume 18, Number 1
Understanding pain and spinal cord injury
As anyone with SCI knows only too well, chronic pain is a frequent problem after SCI and often causes more disability than the paralysis itself. Pain after SCI can be so severe and disabling that some people have said they would give up the possibility of neurological recovery in favor of pain relief. Because chronic SCI pain is such a widespread problem and so difficult to treat, this issue of SCI Update is devoted to pain after SCI: understanding it, treating it and living with it.
Types and causes of SCI pain
People with SCI often experience many different types and locations of pain, and this is one of the things that makes pain after SCI so difficult to treat. Each kind of pain may require a different treatment approach. While acute pain has an identifiable cause and goes away when the cause is treated or eliminated, chronic pain is ongoing, long-standing, persistent and stubborn, and often a specific source cannot be identified.
Neuropathic pain
This is the most common type of chronic pain in the SCI population and the hardest to treat. Neuropathic pain is usually felt at or below the injury level, but can also occur above the level of injury. It is caused by abnormal signals to the brain from the nerves that were damaged by your SCI. A person can feel neuropathic pain in areas that have no sensation.
Your physician may order an X-ray or MRI (magnetic resonance imaging) of your spine to make sure there is no bone or spinal cord abnormality such as a syrinx (a cavity that develops in the spinal cord of about 2% of the SCI population). If tests do not find a specific problem, then your pain probably is caused by the abnormal signals from your SCI.
Many different medications are used for neuropathic pain, including antidepressants at low doses, anticonvulsants such as gabapentin, narcotics (morphine, codeine), nonsteroidal anti-inflammatory drugs (ibuprofen) and others. Sometimes combinations of drugs work better than a single drug. In some cases, treating spasticity helps reduce the pain.
Musculoskeletal and visceral pain
Musculoskeletal pain comes from problems in the muscles, bones or tendons and is common in the general population as people age. In SCI, chronic musculoskeletal pain can be caused by overuse or strain, arthritic changes, or wear and tear of the joints, often from wheelchair use. Treatment usually includes physical therapy, changes in equipment, medication, or all three.
Visceral or abdominal pain is located in the stomach and digestive area and can be caused by undiagnosed gastrointestinal problems such as ulcers, constipation or appendicitis. Since a person with SCI may not have the usual symptoms associated with these medical conditions, a physician with limited experience caring for SCI patients may have difficulty making the correct diagnosis and prescribing the right treatment. If no abdominal problem or disease can be found, then the pain is considered to be neuropathic pain that is caused by abnormal nerve signals but felt in the abdomen.
Non-drug treatments
There are many methods of managing pain besides drugs. Massage, acupuncture, aerobic exercise, yoga, stress reduction techniques, hypnosis and other psychological techniques are sometimes helpful in reducing or relieving SCI pain. Discuss these treatments with your physician before trying them. It is important to find reputable practitioners of these therapies who have experience working with individuals who have SCI.
Prevention and self-care
- Overall health can have a big impact on pain. Good diet, healthy weight and regular exercise improve overall health. Pain can get worse or harder to treat if you are rundown, suffering repeated urinary infections or not getting enough sleep.
- Get prompt treatment for medical problems. Urinary tract infections and spasticity can make pain worse.
- Get a wheelchair seating evaluation. Poor posture and improper wheelchair technique can cause serious pain problems.
- Pay attention to your emotional health. Stress, depression and other emotional upsets often make pain worse. Counseling or other treatments can help.
- Consider trying some of the techniques described in “Pain and the Brain” (page 1).