Spinal Cord Injury-Related Pain

Brief Overview: Chronic pain is a common and complex complication of spinal cord injury, often involving multiple mechanisms. Pain can be neuropathic (nerve-related), musculoskeletal, or visceral and may persist for years after the injury. It significantly impacts function, mental health, and quality of life in patients with SCI.

Prevalence: According to UpToDate, “Reported prevalences vary considerably. On average, two-thirds of patients suffer chronic pain and approximately one-quarter to one-third of patients have severe pain that significantly affects quality of life.”

Etiology:

  • Neuropathic pain: damaged spinal cord pathways, abnormal nerve signaling.
  • Musculoskeletal pain: overuse of shoulders/arms with wheelchair use or transfers, posture issues.
  • Visceral pain: bowel, bladder, or abdominal complications.
  • Secondary complications: pressure sores, infections, spasticity.

Risk Factors:

  • Higher level or more severe SCI.
  • Complete vs. incomplete spinal cord injuries.
  • Older age at time of injury.
  • Prolonged immobility.
  • Poor posture, wheelchair dependence.
  • Depression and anxiety.

Commonly Associated Conditions:

  • Depression, anxiety, PTSD.
  • Sleep disturbance, fatigue.
  • Spasticity and contractures.
  • Pressure ulcers, urinary tract infections, constipation.
  • Autonomic dysreflexia in high-level SCI.

Common Medications:

  • NSAIDs, Tylenol
  • Anti-seizure medications like gabapentin
  • Muscle relaxers
  • Antidepressants
  • Topicals like lidocaine
  • Opioids
  • Intrathecal morphine, clonidine, baclofen

Common Labs, Imaging, and Tests:

  • Diagnosis is typically made clinically
  • Imaging (X-ray, MRI) if new/worsening musculoskeletal pain or hardware complication.
  • Labs (CBC, metabolic panel) if systemic infection suspected.
  • Pain questionnaires (Neuropathic Pain Scale, Numeric Pain Rating).

Common Symptoms:

  • Neuropathic: burning, shooting, tingling, electric shock-like pain below level of injury.
  • Musculoskeletal: dull, aching pain in overused joints (shoulders, neck, back).
  • Visceral: abdominal cramps, bladder pain, constipation-related pain.
  • Pain may be constant or triggered by activity.
  • Associated with sleep problems, mood changes, reduced mobility.

Common Treatments:

  • Physical therapy
  • Changing your activity or equipment
  • TENS
  • Acupuncture
  • Relaxation techniques
  • CBT
  • Spinal cord stimulation may be indicated, or an option, for some

Physical Findings:

  • May be normal despite severe reported pain.
  • Neuropathic: sensory changes (allodynia, hyperalgesia, numbness).
  • Musculoskeletal: joint/muscle tenderness, limited ROM, abnormal posture.
  • Spasticity, contractures, muscle atrophy.
  • Pressure ulcers or skin breakdown may be present.

Potential Complications and Contraindications:

  • Complications:
    • Severe disability, reduced independence.
    • Depression, anxiety, substance misuse.
    • Pressure ulcers, infections due to immobility.
    • Falls or injuries from spasticity or weakness.
  • Contraindications:
    • NSAIDs: avoid in renal disease, GI bleed risk.
    • TCAs: caution in older adults (cardiac risk, anticholinergic side effects).
    • Muscle relaxants: risk of sedation, falls in seniors.
    • Chronic opioid therapy: high risk of dependence, limited long-term benefit.

General Health and Lifestyle Guidance:

  • Encourage daily stretching and gentle activity as tolerated.
  • Maintain skin care and pressure relief routines to prevent ulcers.
  • Ensure wheelchair fit and posture are optimized.
  • Prioritize sleep hygiene and stress management.
  • Balanced diet with adequate hydration and bowel regimen.
  • Support mental health with counseling or peer groups.
  • Encourage regular follow-up with rehabilitation and pain specialists.

Suggested Questions to Ask Patients:

  • Where is your pain located, and how would you describe it?
  • How long have you had this pain, and what makes it better or worse?
  • Does the pain interfere with sleep, mood, or daily activities?
  • Do you use a wheelchair or assistive devices — do they cause discomfort?
  • What medications or treatments are you currently using for pain? Do they help?
  • Do you have muscle spasms, stiffness, or skin sores?
  • How does pain affect your independence and quality of life?

Suggested Talking Points:

  • Chronic pain after a spinal cord injury is very common and can come from nerves, muscles, or even posture.
  • You will likely use a combination of treatments — not just medications — to help manage your pain.
  • Neuropathic pain medicines like gabapentin or duloxetine may help with nerve-related pain.
  • Physical therapy, proper wheelchair support, and gentle activity can reduce muscle strain.
  • Pain can affect mood and sleep — treating both physical and emotional health is important.

 

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner