Pain in a Spinal Cord Injury

Overview

Pain in an SCI can be complicated and confusing. You may feel pain where you have feeling. But you may also feel pain in an area where otherwise you have no feeling. The pain may be severe at some times. But at other times it may disappear or bother you only a little.

Don't ignore your pain. Talk to your doctor about it. The doctor can help figure out the type of pain and how to manage it. Also, pain can signal a more serious problem.

There are different types of pain, and they are often described in different ways.

Neuropathic pain

Neuropathic pain around the injury area is the most common type of pain with an SCI. This pain is caused by damage to the nervous system.

This type of pain may occur in different areas of the body. For example:

• Spinal cord injury (central) pain occurs in areas where you have lost some or all of your feeling. It's not related to your movements or your position. It is often described as tingling, numbness, or throbbing.
• Segmental pain often occurs around the "border" between where you have feeling and don't have feeling.
• Nerve root pain occurs at or just below the level of injury. It causes brief instances of sharp pain or burning pain where your normal feeling stops. Even touching the area lightly may make the pain worse.

Musculoskeletal pain

Musculoskeletal pain occurs in the bones, joints, and muscles. The pain is usually made worse by movement and eased with rest. It's often described as a dull or aching pain.

There are different types of musculoskeletal pain.

• Secondary overuse pain is caused by the overuse of muscles in any part of the body. In people with an SCI, this often occurs because one muscle group is always used. For example, it may occur in the arm or shoulder as a result of pushing a manual wheelchair.
• Muscle spasm pain is painful involuntary movements (spasms) of a body part that you can't move or can only partially move. The pain is caused when muscles and joints are strained.

Visceral pain

Visceral pain occurs in the belly. The pain can be described as burning, cramping, and constant.

Treatment

Treatment for pain from an SCI depends on the type of pain you have. Treatments may include:

Complementary therapies.

These may help reduce pain. They may also help you cope with stress and improve your emotional and physical well-being. These therapies include:

• Acupuncture. This involves putting very thin needles into the skin at certain points on the body.
• Biofeedback. This is a method of consciously controlling something that is normally controlled automatically by the body, such as skin temperature.
• Guided imagery. This is a series of thoughts and suggestions that direct a person's imagination toward a relaxed, focused state.
• Hypnosis. This is a state of focused concentration. In hypnosis, a person becomes less aware of their surroundings. Some people learn to manage pain by concentrating in this way.
• Yoga. This uses meditation and exercise. Yoga helps you improve your breathing, be more flexible, reduce stress, and stay healthy.

Transcutaneous electrical nerve stimulation (TENS).

This treatment applies brief pulses of electricity to nerve endings in the skin. It can relieve chronic pain.

Counseling (such as cognitive-behavioral therapy).

This focuses on your mental health and conditions such as stress and depression. These can happen along with chronic pain and can make it worse. To recover from your chronic pain, it's important to take care of your emotional health and your physical health.

Medicines for neuropathic pain.

These include anticonvulsants (such as gabapentin) and tricyclic antidepressants (such as amitriptyline).

Anesthetic medicine or surgery.

Segmental pain may be treated by injecting an anesthetic medicine into the space between the wall of the spinal canal and the covering of the spinal cord. This is called an epidural block. Or surgical procedures that cut nerve roots may be used for this type of pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen.

These may be used to treat secondary overuse pain. Limiting or taking breaks from the activity that causes pain may also help.

Antispasmodics such as baclofen and tizanidine (Zanaflex).

These are used to treat muscle spasm pain.

If you have pain, don't ignore it. Talk to your doctor. Pain can be a sign of a more serious problem.