Pain in a spinal cord injury

Content provided by Healthwise

Pain in a spinal cord injury

Pain in a spinal cord injury (SCI) can be complicated and confusing. There are different types of pain, and they are often described in different ways. 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.

The most common type of pain experienced with SCI is neuropathic pain around the injury area. This is also known as the "circle of fire" or the "ring of fire." Neuropathic pain is caused by damage to the nervous system. Other types of pain include musculoskeletal (pain in the bones, muscles, and joints), and visceral (pain in the abdomen).

Neuropathic pain

Neuropathic pain is caused by damage to the nervous system. It is common in SCIs.

• Spinal cord injury (central) pain occurs in areas where you have lost some or all of your feeling. It is not related to movements you make or to your position. It is often described as tingling, numbness, or throbbing. This is sometimes called "the circle of fire."
• Segmental pain often occurs around the "border" between where you have feeling and do not have feeling.
• Nerve root entrapment pain occurs at or just below the level of injury. It results in 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. Unlike neuropathic pain, movement affects it, and it is usually made worse by movement and eased with rest. It is often described as a dull or aching 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 develop 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 cannot move or can only partially move. The pain is caused when muscles and joints are strained.

Visceral pain

Visceral pain occurs in the abdomen (stomach area). The pain can be described as burning, cramping, and constant.

Treatment

If you have pain, do not ignore it. Talk to your health professional. You need to know the type of pain and its cause to manage it. And pain can signal a more serious problem.

• Several classes of medications are used for neuropathic pain. These include antiepileptic drugs, such as gabapentin; tricyclic antidepressants, such as amitriptyline; and opioid analgesics, such as morphine or codeine.
  • Segmental pain may also be treated by injecting an anesthetic medication into the space between the wall of the spinal canal and the covering of the spinal cord (epidural block) or with surgical procedures that cut nerve roots.
• Secondary overuse pain is treated through nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. Limiting the activity that causes pain is also useful, such as taking breaks during the activity.
• Muscle spasm pain is treated through antispasmodics such as tizanidine (Zanaflex) and baclofen (Lioresal). A review of research notes that having baclofen injected into the spinal cord area or taking tizanidine reduced spasticity compared to a placebo. However, the review also notes that there is not enough evidence on these medications as used in spinal cord injuries.¹

References

Citations

1. Taricco M, et al. (2006). Pharmacological interventions for spasticity following spinal cord injury. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

Credits

Last updated:	February 22, 2007
Author:	Kathe Gallagher, MSW
Reviewed By:	Adam Husney, MD - Family Medicine, Nancy Greenwald, MD - Physical Medicine and Rehabilitation
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC