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Spinal cord injury pain

Pain after spinal cord injury is common and takes several distinct forms — musculoskeletal pain from overworked structures, neuropathic pain at or below the level of injury, and visceral pain. Each has different treatment, so separating them is the essential first step.

Pain is one of the most common and most limiting consequences of spinal cord injury, and one of the least well served. It is frequently dismissed as inevitable, treated with escalating medication aimed at the wrong mechanism, or simply never properly classified. Classification is the key, because spinal cord injury produces several genuinely different kinds of pain that respond to different things.

Musculoskeletal pain comes from structures above the injury doing work they were never designed for. Shoulders that propel a wheelchair and lift a body through transfers develop rotator cuff disease and joint pain at high rates; the neck and upper back strain; the spine around the injury level can be painful from instrumentation or altered load. This pain behaves like other musculoskeletal pain — worse with use, better with rest — and responds to the same logic: accurate diagnosis, targeted injections where indicated, and adjustment of technique, posture and equipment to reduce the ongoing insult.

Neuropathic pain is generated by the damaged cord and nerve roots themselves. At the level of injury it is often a band of burning or electric pain; below the level it can be felt in areas with little or no normal sensation — burning, crushing or shooting pain in legs that cannot feel touch. This is disorienting and often disbelieved, but it is real and typical. Treatment centres on medications matched to nerve pain mechanisms, and, in carefully selected people with severe refractory pain, options including supervised infusion therapy or neuromodulation are considered after full assessment.

Visceral and other pain. Pain from internal organs — bowel, bladder — can be felt in altered or referred patterns, and new or changing pain in someone with a spinal cord injury always warrants checking that a treatable medical problem is not being missed: a kidney stone, a fracture, syringomyelia. Assessment takes this seriously rather than attributing everything to the injury.

Where spasticity fits. Spasticity and pain interact — spasms are painful, pain worsens spasticity — and treating one often helps the other. Both sit within the same assessment here, alongside pressure care, seating and function, because Dr Martin's rehabilitation training included spinal cord injury medicine and this whole-person view is the working model of the practice.

Realistic goals. For cord-generated neuropathic pain, complete relief is uncommon and honest care says so. Meaningful reduction, better sleep, preserved shoulder function and maintained independence are achievable goals, and the difference they make is substantial.

Sources: International Association for the Study of Pain; Healthdirect Australia.