Pain in the Spinal Cord Injury Rehabilitation Patient

Abstract

Pain in patients with spinal cord injury (SCI) is very common and often difficult to treat. There are unique conditions that may develop after spinal cord injury. Pain providers who work with SCI patients must be able to recognize and treat these conditions. Each spinal cord injury is unique; patients may have complete paralysis with absent sensation below the level of injury, or they may have only subtle neurological deficits depending on the location and severity of the injury. Pain after SCI may be caused by direct damage to the peripheral nerves or the spinal cord; it may be referred by areas of the body with abnormal sensation or from internal organs; it may be caused by spasticity. An understanding of the changes to the nervous system after SCI is essential. In addition to neurological pain conditions, SCI patients are at increased risk for upper extremity musculoskeletal conditions.

We discuss the various types of pain and pain syndromes that may be present in these individuals. We review useful tools for practitioners to help categorize the common, severe, and elusive pain in individuals with spinal cord injury. We will cover various treatment methods, including complementary and alternative therapies, psychological treatment methods, medications, interventional procedures, and surgical options. In most cases, a multifaceted approach to pain management will be more successful than a single therapy or intervention.