Pain is a frequent issue following a spinal cord injury (SCI). The damage disrupts communication between the brain and body, leading to persistent pain that can interfere with daily life and rehabilitation. Managing this pain is a part of recovery that aims to improve function and quality of life. The treatment approach depends on the specific type of pain experienced.
Understanding Pain After Spinal Cord Injury
Following a spinal cord injury, individuals can experience several distinct types of pain. The most common is neuropathic pain, which originates from the damaged nerves of the spinal cord itself. This disruption in nerve signals causes the brain to receive abnormal messages, which it interprets as pain. People often describe these sensations as burning, tingling, shooting, or like an electric shock. This pain can occur in a band-like distribution around the level of the injury or below it.
Another category is musculoskeletal pain, which involves the muscles, bones, and joints. This pain is not caused by nerve damage directly, but by the physical strain placed on the body after the injury. For example, individuals using a manual wheelchair may develop shoulder or hand pain from the repetitive motion. Muscle stiffness, spasms, and changes in posture can also strain the back and neck.
A third type is visceral pain, which is felt in the abdominal or pelvic regions and is characterized as a dull, cramping sensation. It arises from internal organs and can be related to changes in bladder or bowel function that often accompany an SCI. Identifying the type of pain a person is experiencing is the first step for healthcare providers to determine the most effective treatment.
Medication-Based Treatments
For musculoskeletal discomfort, over-the-counter (OTC) pain relievers are a frequent starting point. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can be effective for pain caused by inflammation in muscles and joints. Acetaminophen is another common option that works to reduce pain signals.
Neuropathic pain requires different classes of medication. Anticonvulsants, such as gabapentin and pregabalin, are first-line treatments that work by calming overactive nerve signals. Certain antidepressants, particularly tricyclic antidepressants like amitriptyline, are also used to manage this pain by altering chemical messengers in the brain and spinal cord.
Opioids, including morphine and oxycodone, may be prescribed for severe pain, particularly in the short term after an injury or surgery. However, these medications carry risks, including dependence, tolerance, and side effects like constipation, which can be problematic for individuals with SCI. For localized pain, topical treatments like creams or patches with agents such as lidocaine or capsaicin can be applied to the skin for targeted relief.
Therapeutic and Rehabilitative Strategies
Beyond medication, non-invasive therapies are a large part of long-term pain management. Physical therapy (PT) focuses on musculoskeletal pain through targeted exercises to strengthen muscles, stretch tight areas, and improve posture. Consistent physical therapy can also help prevent secondary complications like muscle atrophy.
Occupational therapy (OT) helps individuals manage pain by adapting their daily routines and environments. An occupational therapist teaches new, less strenuous ways to perform tasks like dressing or transferring from a wheelchair. They can also recommend adaptive equipment, such as modified computer controls or ergonomic cushions, to minimize pain triggers and improve comfort during daily activities.
Psychological approaches are also valuable for managing the impact of chronic pain. Cognitive Behavioral Therapy (CBT) helps individuals change their thought patterns about pain and develop effective coping strategies. Techniques like mindfulness, meditation, and biofeedback can also be used to manage the emotional and physiological responses to ongoing pain.
Interventional and Procedural Options
For severe pain that does not respond to medication or therapy, more invasive procedures may be considered. Nerve blocks involve injecting an anesthetic or an anti-inflammatory steroid near a specific nerve or joint. This procedure can interrupt pain signals, providing temporary or lasting relief, and can also be used to help diagnose the source of the pain.
Spinal cord stimulation (SCS) is an advanced treatment that involves implanting a small device. This device delivers low-level electrical impulses to the spinal cord, which interfere with pain signals before they can reach the brain. Patients can control the stimulation intensity with an external remote. This option is reserved for those with chronic, intractable neuropathic pain.
An intrathecal drug pump offers an alternative to oral medications. This surgically implanted pump delivers small, continuous doses of medication, like baclofen or morphine, directly into the fluid surrounding the spinal cord. This direct delivery allows for lower doses than oral administration, which can reduce side effects.
In specific cases where a clear structural problem is the cause of pain, major surgery to correct the issue may be considered, though it is a rare solution.