Pain after spinal cord injury

Pain is a common experience following spinal cord injury (SCI) and can significantly impact quality of life.

Types of pain

Different types of pain may occur either separately or together, depending on each person’s unique circumstances.

Acute pain occurs soon after onset of a SCI and may result from a range of factors, including:

• damage to bones, muscles or ligaments at the site of the SCI 
• associated injuries, such as fractures, muscular or ligament damage in the limbs, or internal abdominal injuries
• surgery.

Acute pain can be severe in intensity but typically improves over a few weeks or short months with standard pain management.

Persistent (chronic) pain lasts for a longer duration—often months or years—regardless of the original cause. It can be more difficult to manage and may have a greater impact on overall wellbeing.

Nociceptive pain types

Nociceptive pain is caused by damage to somatic or visceral structures in the body. It includes:

• Musculoskeletal pain: pain arising from bones, ligaments and joints.
• Visceral pain: pain originating from internal organs.

Neuropathic pain types 

Neuropathic pain arises from damage to the nervous system. In SCI it may occur:

• at or below the level of injury: referred to as central neuropathic pain
• above the level of injury: referred to as peripheral neuropathic pain.

Nociplastic pain

When pain has persisted for longer than a few weeks, our pain system becomes hypersensitive. This is called nociplastic pain and its development and severity are dependent on multiple factors. Pain is our bodies way of protecting us and in nociplastic pain our system becomes overprotective, amplifying the pain sensations and their effects on our mood, sleep and behaviour. Fortunately, it is possible to “turn down the volume” on this increased pain experience. Much of the recent research in the treatment of chronic pain focusses on ways to do this. For a brief explanation of nociplastic pain, please see the video below.

The pain experience 

In addition to the types of pain a person may experience following spinal cord injury, it is important to recognise the various factors that can influence the overall pain experience.

Effective pain management is a vital component of rehabilitation and should be approached within a biopsychosocial framework. This model provides a holistic understanding of pain by considering the interaction between biological, psychological and environmental influences.

Given the complex and individual nature of pain after spinal cord injury, a multidisciplinary approach is recommended to support optimal rehabilitation outcomes.