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Management of Pain After Spinal Cord Injury

  • Spinal Cord Injury Rehabilitation (CL Sadowsky, Section Editor)
  • Published:
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Abstract

Chronic pain affects most people with spinal cord injury (SCI). It often impedes performance of activities of daily living and negatively impacts quality of life. Pain after SCI can be classified into subtypes through use of the International SCI Pain Classification with key attributes of the pain necessary for effective monitoring and treatment collected within the International SCI Pain Basic Data Set. Many nociceptive causes of pain seen after SCI are potentially treatable and preventable through the implementation of strategies for preventing overuse injuries. Neuropathic pain, in contrast, has been historically difficult to treat. Options for the treatment of neuropathic pain types which have demonstrated some effectiveness include various adjuvant pharmacological agents, neuromodulatory techniques, and psychological approaches.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Loeser JD, Treede RD. The Kyoto protocol of IASP basic pain terminology. Pain. 2008;137:473–7.

    Article  Google Scholar 

  2. Cardenas DD, Bryce TN, Shem K, Richards JS, Elhefni H. Gender and minority differences in the pain experience of people with spinal cord injury. Arch Phys Med Rehabil. 2004;85:1774–81.

    Article  Google Scholar 

  3. Stormer S, Gerner HJ, Gruninger W, et al. Chronic pain/dysaesthesiae in spinal cord injury patients: results of a multicentre study. Spinal Cord. 1997;35:446–55.

    Article  CAS  Google Scholar 

  4. Jensen TS, Baron R, Haanpaa M, et al. A new definition of neuropathic pain. Pain. 2011;152(10):2204–5.

    Article  Google Scholar 

  5. • Bryce TN, Biering-Sorensen F, Finnerup NB, et al. International spinal cord injury pain classification: part I. Background and description. Spinal Cord. 2012;50:413–17. This manuscript describes the classification of pain after SCI.

  6. Widerstrom-Noga E, Biering-Sorensen F, Bryce TN, et al. The international spinal cord injury pain basic data set (version 2.0). Spinal Cord. 2014;52:282–6.

    Article  CAS  Google Scholar 

  7. International Spinal Cord Society (ISCoS). International SCI Data Sets. http://www.iscos.org.uk/international-sci-data-sets. Accessed 15 Apr 2015.

  8. Dyson-Hudson TA, Kirshblum SC. Shoulder pain in chronic spinal cord injury, part I: epidemiology, etiology, and pathomechanics. J Spinal Cord Med. 2004;27:4–17.

    Article  Google Scholar 

  9. Bayley JC, Cochran TP, Sledge CB. The weight-bearing shoulder. The impingement syndrome in paraplegics. J Bone Joint Surg Am. 1987;69:676–8.

    Article  CAS  Google Scholar 

  10. Gellman H, Sie I, Waters RL. Late complications of the weight-bearing upper extremity in the paraplegic patient. Clin Orthop Relat Res. 1988;233:132–5.

    Google Scholar 

  11. Sie IH, Waters RL, Adkins RH, Gellman H. Upper extremity pain in the postrehabilitation spinal cord injured patient. Arch Phys Med Rehabil. 1992;73:44–8.

    CAS  PubMed  Google Scholar 

  12. Curtis KA, Tyner TM, Zachary L, et al. Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users. Spinal Cord. 1999;37:421–9.

    Article  CAS  Google Scholar 

  13. Serra-Ano P, Pellicer-Chenoll M, Garcia-Masso X, Morales J, Giner-Pascual M, Gonzalez LM. Effects of resistance training on strength, pain and shoulder functionality in paraplegics. Spinal Cord. 2012;50(11):827–31.

    Article  CAS  Google Scholar 

  14. • Van Straaten MG, Cloud BA, Morrow MM, Ludewig PM, Zhao KD. Effectiveness of home exercise on pain, function, and strength of manual wheelchair users with spinal cord injury: a high-dose shoulder program with telerehabilitation. Arch Phys Med Rehabil. 2014;95:1810–17.e2. This article describes an effective program for addressing shoulder pain after SCI.

  15. Samuelsson K, Larsson H, Thyberg M, Tropp H. Back pain and spinal deformity-common among wheelchair users with spinal cord injuries. Scand J Occup Ther. 1996;3(1):28–32.

    Article  Google Scholar 

  16. Bryce TN, Ragnarsson KT. Epidemiology and classification of pain after spinal cord injury. Top Spinal Cord Inj Rehabil. 2001;7:1–17.

    Article  Google Scholar 

  17. Siddall PJ, McClelland JM, Rutkowski SB, Cousins MJ. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain. 2003;103:249–57.

    Article  Google Scholar 

  18. Finnerup NB, Norrbrink C, Trok K, et al. Phenotypes and predictors of pain following traumatic spinal cord injury: a prospective study. J Pain. 2014;15:40–8.

    Article  Google Scholar 

  19. Finnerup NB, Baastrup C. Spinal cord injury pain: mechanisms and management. Curr Pain Headache Rep. 2012;16:207–16.

    Article  Google Scholar 

  20. Kerns RD, Turk DC, Rudy TE. The west haven-yale multidimensional pain inventory (WHYMPI). Pain. 1985;23:345–56.

    Article  CAS  Google Scholar 

  21. Widerstrom-Noga EG, Duncan R, Turk DC. Psychosocial profiles of people with pain associated with spinal cord injury: identification and comparison with other chronic pain syndromes. Clin J Pain. 2004;20:261–71.

    Article  Google Scholar 

  22. Widerstrom-Noga EG, Turk DC. Exacerbation of chronic pain following spinal cord injury. J Neurotrauma. 2004;21:1384–95.

    Article  Google Scholar 

  23. Wilkie DJ, Huang HY, Reilly N, Cain KC. Nociceptive and neuropathic pain in patients with lung cancer: a comparison of pain quality descriptors. J Pain Symptom Manag. 2001;22:899–910.

    Article  CAS  Google Scholar 

  24. • Finnerup NB, Attal N, Haroutounian S, et al. (2015) Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 4:162–73. This is a comprehensive review of the pharmacological treatments of neuropathic pain including after SCI.

  25. Cardenas DD, Nieshoff EC, Suda K, et al. A randomized trial of pregabalin in patients with neuropathic pain due to spinal cord injury. Neurology. 2013;80:533–9.

    Article  CAS  Google Scholar 

  26. Vranken JH, Hollmann MW, van der Vegt MH, et al. Duloxetine in patients with central neuropathic pain caused by spinal cord injury or stroke: a randomized, double-blind, placebo-controlled trial. Pain. 2011;152:267–73.

    Article  CAS  Google Scholar 

  27. Barrera-Chacon JM, Mendez-Suarez JL, Jauregui-Abrisqueta ML, Palazon R, Barbara-Bataller E, Garcia-Obrero I. Oxycodone improves pain control and quality of life in anticonvulsant-pretreated spinal cord-injured patients with neuropathic pain. Spinal Cord. 2011;49:36–42.

    Article  CAS  Google Scholar 

  28. Ray WA, Meredith S, Thapa PB, Hall K, Murray KT. Cyclic antidepressants and the risk of sudden cardiac death. Clin Pharmacol Ther. 2004;75:234–41.

    Article  CAS  Google Scholar 

  29. Fischer B, Jones W, Urbanoski K, Skinner R, Rehm J. Correlations between prescription opioid analgesic dispensing levels and related mortality and morbidity in Ontario, Canada, 2005–2011. Drug Alcohol Rev. 2014;33:19–26.

    Article  Google Scholar 

  30. Bohnert AS, Ilgen MA, Trafton JA, et al. Trends and regional variation in opioid overdose mortality among veterans health administration patients, fiscal year 2001 to 2009. Clin J Pain. 2014;30:605–12.

    PubMed  Google Scholar 

  31. Tan G, Rintala DH, Thornby JI, Yang J, Wade W, Vasilev C. Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury. J Rehabil Res Dev. 2006;43:461–74.

    Article  Google Scholar 

  32. Fregni F, Boggio PS, Lima MC, et al. A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Pain. 2006;122:197–209.

    Article  Google Scholar 

  33. Soler MD, Kumru H, Pelayo R, et al. Effectiveness of transcranial direct current stimulation and visual illusion on neuropathic pain in spinal cord injury. Brain. 2010;133:2565–77.

    Article  Google Scholar 

  34. Wrigley PJ, Gustin SM, McIndoe LN, Chakiath RJ, Henderson LA, Siddall PJ. Longstanding neuropathic pain after spinal cord injury is refractory to transcranial direct current stimulation: a randomized controlled trial. Pain. 2013;154:2178–84.

    Article  Google Scholar 

  35. Ngernyam N, Jensen MP, Arayawichanon P, et al. The effects of transcranial direct current stimulation in patients with neuropathic pain from spinal cord injury. Clin Neurophysiol. 2015;126:382–90.

    Article  Google Scholar 

  36. Tasker RR, DeCarvalho GT, Dolan EJ. Intractable pain of spinal cord origin: clinical features and implications for surgery. J Neurosurg. 1992;77:373–8.

    Article  CAS  Google Scholar 

  37. Cioni B, Meglio M, Pentimalli L, Visocchi M. Spinal cord stimulation in the treatment of paraplegic pain. J Neurosurg. 1995;82:35–9.

    Article  CAS  Google Scholar 

  38. Cruccu G, Aziz TZ, Garcia-Larrea L, et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol. 2007;14:952–70.

    Article  CAS  Google Scholar 

  39. Robert R, Perrouin-Verbe B, Albert T, Bussel B, Hamel O. Chronic neuropathic pain in spinal cord injured patients: what is the effectiveness of surgical treatments excluding central neurostimulations? Ann Phys Rehabil Med. 2009;52:194–202.

    Article  CAS  Google Scholar 

  40. Falci S, Best L, Bayles R, Lammertse D, Starnes C. Dorsal root entry zone microcoagulation for spinal cord injury-related central pain: operative intramedullary electrophysiological guidance and clinical outcome. J Neurosurg Spine. 2002;97:193–200.

    Article  Google Scholar 

  41. Gault D, Morel-Fatio M, Albert T, Fattal C. Chronic neuropathic pain of spinal cord injury: what is the effectiveness of psychocomportemental management? Ann Phys Rehabil Med. 2009;52:167–72.

    Article  CAS  Google Scholar 

  42. Norrbrink Budh C, Kowalski J, Lundeberg T. A comprehensive pain management programme comprising educational, cognitive and behavioural interventions for neuropathic pain following spinal cord injury. J Rehabil Med. 2006;38:172–80.

    Article  Google Scholar 

  43. Boninger ML, Cooper RA, Baldwin MA, Shimada SD, Koontz A. Wheelchair pushrim kinetics: body weight and median nerve function. Arch Phys Med Rehabil. 1999;80:910–5.

    Article  CAS  Google Scholar 

  44. Boninger ML, Impink BG, Cooper RA, Koontz AM. Relation between median and ulnar nerve function and wrist kinematics during wheelchair propulsion. Arch Phys Med Rehabil. 2004;85:1141–5.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1240B, New York, NY, 10029-6574, USA

    Thomas N. Bryce

  2. Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, 3 East 101st Street, 1st Floor, New York, NY, 10029-6574, USA

    Jennifer Gomez

Authors
  1. Thomas N. Bryce
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  2. Jennifer Gomez
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Corresponding author

Correspondence to Thomas N. Bryce.

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This article is part of the Topical Collection on Spinal Cord Injury Rehabilitation.

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Bryce, T.N., Gomez, J. Management of Pain After Spinal Cord Injury. Curr Phys Med Rehabil Rep 3, 189–196 (2015). https://doi.org/10.1007/s40141-015-0092-3

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  • DOI: https://doi.org/10.1007/s40141-015-0092-3

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