Pain after spinal cord injury
Pain is a common experience following spinal cord injury and can impact upon quality of life.
Types of pain
There are different types of pain which can be experienced separately or at the same time, depending on each person’s unique circumstances.
Acute pain occurs soon after onset of a spinal cord injury and can be caused by a range of factors, including:
- damage to bones, muscles and/or ligaments at the location of the spinal cord injury;
- damage with other injuries (e.g., fractures, muscular or ligament injuries of limbs, internal abdominal injuries); and/or
- surgery.
Acute pain can be severe in intensity but will usually improve over a few weeks or short months with standard pain management.
Persistent or chronic pain is another type of pain that persists for a longer period of time, often months or years, regardless of the original cause. Persistent pain can be more difficult to manage and have a greater impact on a person’s wellbeing.
Nociceptive pain types
Nociceptive pain is caused by damage to somatic or visceral structures in the body, including pain to muscles and joints (i.e., musculoskeletal pain) and pain to organs (i.e., visceral pain).
Musculoskeletal pain
- Caused by damage to bones, ligaments, muscles and joints.
- Typically felt above the level of injury or in areas where feeling is preserved below the level of injury.
- Often described as dull and aching.
- Can be seen in acute phase post-injury or with chronic overuse.
Visceral pain
- Believed to be caused by visceral structures that have some dysfunction or pathology (e.g., bladder or bowel).
- Described as dull, aching or cramping.
- Examples include urinary tract infection and faecal impaction.
Neuropathic pain types
Neuropathic pain arises from damage to nerve structures, including pain at or below the level of the spinal cord injury (i.e., central pain) or pain above the level of the spinal cord injury (i.e., peripheral pain).
Central pain
At level
- Often felt in the dermatomes close to level of injury.
- Described as band of burning, electric or shooting pain or hypersensitivity.
Below level
- Located diffusely below level of injury, usually bilaterally.
- Described the same as at level pain.
Allodynia
- Described as pain due to a stimulus that does not normally provoke pain (e.g., light touch or breeze over the skin).
- Often presents early onset after injury and may disappear within 6 months.
Peripheral pain
Above level
- From a cause not linked with spinal cord lesion (e.g., neuropathies such as carpal tunnel syndrome or complex regional pain syndromes).
The pain experience
In addition to the types of pain a person might experience after spinal cord injury, it is important to understand and explore the various factors that can modulate or affect the pain experience.
Effective pain management is a key part of rehabilitation and should be addressed within a biopsychosocial framework (see Figure 1 below). This approach ensures a comprehensive understanding of the person’s pain, taking into account the biological, psychological and environmental factors that can all contribute their experience.
Due to the complexity and individual nature of pain following spinal cord injury, a multi-disciplinary approach is recommended to achieve the best possible rehabilitation outcomes.
Figure 1. Biopsychosocial framework of pain
Source: Middleton, J., Siddall, P., & Nicholson Perry, K. (2008). Managing Pain for Adults with Spinal Cord Injury. Rural Spinal Cord Injury Project.
Below are some additional resources that may help in understanding pain after spinal cord injury:
Queensland Health – Persistent pain management services
NSW Pain Management Network – Resources for Chronic Pain
Lorimer Moseley – Why Things Hurt
Curable: A Different Approach to Chronic Pain
Bryce, T. N., Biering-Sørensen, F., Finnerup, N. B., Cardenas, D. D., Defrin, R., Lundeberg, T., Norrbrink, C., Richards, J. S., Siddall, P., Stripling, T., Treede, R. D., Waxman, S. G., Widerström-Noga, E., Yezierski, R. P., & Dijkers, M. (2012). International spinal cord injury pain classification: part I. Background and description. March 6-7, 2009. Spinal cord, 50(6), 413–417.
Mehta, S., Teasell, RW., Loh, E., Short, C., Wolfe, DL., Benton, B., Blackport, D., Hsieh, JTC. (2019). Pain Following Spinal Cord Injury. In Eng, JJ., Teasell, RW., Miller, WC., Wolfe, DL., Townson, AF., Hsieh, JTC., Connolly, SJ., Noonan, VK., Loh, E., McIntyre, A (Eds.), Spinal Cord Injury Rehabilitation Evidence. SCIRE Project.
Middleton, J., Siddall, P., & Nicholson Perry, K. (2002). Managing Pain for adults with spinal cord injury. Rural Spinal Cord Injury Project.
Siddall, P., Yezierski, RP., Joeser, JD. (2002). Taxonomy and epidemiology of spinal cord injury pain. In Yezierski, RP., Burchiel, KJ (Eds.), Spinal Cord Injury Pain: Assessment, Mechanisms, Management (pp. 9-24). IASP Press.