Post by Lαrα on May 21, 2015 2:15:35 GMT -8
Spinal Cord Injury brings enough challenges but for approximately 40% off individuals who have a Spinal Cord Injury, will have or develop longterm chronic pain at some point in their life.
I know personally what it is like to experience chronic pain and it offers no respite so it is no surprise that pain can lead to depression!
Musculoskeletal pain begins when our muscles are overworked. It can start from over use or from metabolic issues such as arthritis. For individuals that propel wheelchairs, the repetitive motion of reaching back for the wheel can lead to shoulder pain.
Not extending the shoulder and arm back so far can resolve this over time.
It seems simple but when people are on the go, it is hard to remember not to overstretch. Your therapist can help you adjust your seating to protect your shoulder joints to avoid issues later.
Back and neck pain can result from overuse of muscles which now compensate for those that don’t work so well. Changing positions from chair to bed can rest these muscles as you build tolerance.
I tend to suffer with this pain if I attempt to walk too much! Knowing what type of pain you are experiencing will help you to get the right treatment to help with the pain.
Referred pain is discomfort in an area as the result of an issue in another part of the body. Most people are familiar with left arm pain during a heart attack. This is an example of referred pain. Individuals with spinal cord injury will often have referred pain if they have a metabolic problem in their body. Gall bladder attacks may be felt in the shoulder.
Sometimes, individuals with SCI will feel pain sensations in other parts of their bodies during the pinprick or light touch part of physical examinations.
This is a result of the body trying to reorganize the nervous system. Remember the part of your body below a spinal cord injury still functions, but messages cannot get through the injured part of the spinal column.
Therefore, the pain message is trying to get through using an alternate route that might not make any sense. Noting referred pain to your healthcare practitioner is always going to be beneficial to you as a professional who treats spinal cord injury will look for the source of the referred pain. This can be very useful in making a diagnosis especially of metabolic problems. Treating the underlying issue will relive referred pain.
Neuropathic or neurogenic pain
Neuropathic or neurogenic pain is pain from miscommunication stemming from the nerves. If the pathway for sending the message of pain to the brain is blocked, the message will try to go to the brain by another route. This is similar to the process for referred pain but in this case, the nerve, itself is going haywire, not always as a direct response to injury or discomfort.
This type of pain has the symptoms of tingling, burning, electrical or other types of shooting or stabbing pain.
It occurs in both the central nervous system (brain and spinal cord) and the peripheral nervous system (all of the nerves in the body outside of the brain and spinal cord).
Treating neuropathic pain can be challenging and may take time until the right treatment or combination of treatments is found for you.
Medications may be tried starting with lotions rubbed on the skin (topical) that contain numbing agents such as lidocaine. Medications by mouth include gabapentin and pregabalin. These are medications specifically formulated for pain caused by the nerves.
Often times, some psychiatric medications are taken in lower does for nerve pain.
These might include tricyclic antidepressants. Because these are taken in such low doses, they will not affect any mental processes, only neuropathic pain. Mixed serotonin-norepinephrine reuptake inhibitors by also be tried which will reorganize the pain message. Narcotics can be tried but narcotics dull the pain message in your brain, not the message itself.
You must be aware of the risks of addiction and sedation compared to the benefit of possible pain relief. All medications should be reviewed for risks and benefits before making the decision to try them for pain relief. You don’t want to become addicted to a medication that is not benefitting your pain relief so work closely with your healthcare professional when attempting any treatment.
Surgical treatment for neuropathic pain is only tried when medication fails. This is an extreme treatment. Even with surgical intervention, medication may still be needed. Pumps can be inserted into the spinal column to bathe the spinal cord with narcotics and/or baclofen, a muscle relaxer.
Much higher doses of medication can be delivered as the medication is directly delivered as opposed to being absorbed through the gut although side effects are similar. A dorsal column stimulator can be implanted to interrupt the pain signal to the brain. Surgical procedures carry extra risks for individuals with spinal cord injury.
Prevention is always the best treatment. Keeping your body healthy with exercise, stretching and good nutrition is a great place to start. Getting rest when your body is weary is a good start for musculoskeletal pain.
Reporting referred pain promptly will aid with quick diagnosis of a problem. A wheelchair, seating and bed surface evaluation will detect any issues that alignment or support is not being met.