Definition Spinal cord injury pain is a result of spinal cord injury. Spinal cord injury (SCI) is damage to the spinal cord as a result of a direct trauma to the spinal cord itself or as a result of indirect damage to the bones and soft tissues and vessels surrounding the spinal cord.
There are two kinds of spinal cord injury pain - acute pain and chronic pain. Acute pain begins suddenly. The cause of the pain is usually from physical damage to the body from disease. Acute pain is a danger signal; it means something is wrong and that you need help. When the problem is fixed or the body heals, the pain goes away. Chronic pain may start suddenly or build up slowly over time; sometimes a cause is known, sometimes not. Chronic pain does not go away as you would expect. It is usually not as dangerous as acute pain, but do not ignore it. Chronic pain remains a difficult condition to treat in many persons with SCI.
There are five types of pain commonly felt by those with SCI.
Central Pain (Nerve Pain) Central pain can cause you the most problems. You feel pain where you are not supposed to feel anything or where your feeling is different. Central pain often begins weeks or months after SCI. It can cause a pins and needles feeling, numbness, or a burning feeling throughout the area below your level of injury. The pain may be constant. At best, it is bothersome. At worst, it can be so severe that it limits your ability to function fully in life. Doctors believe the cause of central pain may be changes in the functioning of nerves following SCI. They think that pain signals are really coming from somewhere other than where you think.
Root Pain (Nerve Pain) The pain you feel at, or below, the level of injury is root pain. Root pain has a distinct pattern. It often begins days to weeks after injury and may worsen over time. You may feel brief waves of stabbing or sharp pain or a band of burning pain at the point where your normal feeling stops. You may find that light touch worsens this pain.
Mechanical Pain Mechanical pain can range from sudden sharpness to dull and aching. Physical activity often makes the pain worse. You feel this pain in areas where you have normal sensation. Causes include muscle overuse or damage, unstable bone fractures, infection, or deforming change in your bones and joints.
Syrinx Pain Sometimes as the spinal cord heals itself, a hollow, fluid filled cavity forms, called a syrinx. Although rare, it results in pain that varies in severity and can occur either above or below the site of injury. A syrinx can slowly increase in size and extend up or down the spinal cord. Syrinx pain develops months to years after injury. It can result in gradual loss of organ function, feeling, or movement.
Referred Pain Referred pain is unusual because you feel it in areas away from the source of the problem. The site can be your organs, muscles, or other tissues. In areas where you cannot feel pain, you may see or feel increased muscle spasticity. For example, if you had a heart attack, the pain you might feel might be somewhere in your left arm and shoulder.
Treatment Treatments vary, depending on the type of pain.
Treatment of Acute Pain Acute pain, such as syrinx and referred pain, often responds well to treatment. Treatment of a syrinx involves neurosurgery and the draining of fluid from the syrinx. With referred pain, once the cause is found and treated the pain will stop. Pain caused by unstable fractures stops when the fracture heals or is surgically stabilized. Several techniques can reduce the pain from sore or damaged muscles, stiff joints, or muscle spasms. These include stretching, range of motion exercise, strengthening, heat or cold application, certain medications, and additional methods as well.
Treatment of Chronic Pain Chronic pain, such as root and central pain, can be difficult to treat. There are several treatments available, but no one method works in each case. Some of these methods have unwanted side effects. Others may work at first, then lose their effectiveness over time. Often treatment requires a combination of methods. It is advisable to try the safest treatment first and avoid treatments with greater medical risk. Often, successful treatment requires learning to cope with, rather than curing, the pain.
Medications There are several medications available to treat SCI pain. All have shown some success, but again, none completely in every instance. Some of the side effects of these medications can be serious. Your doctor must closely watch your treatment.
Types of pain medications include: Non-narcotic: Antidepressants are helpful in alleviating pain because they affect the pain pathways. Anticonvulsant (seizure medication such as gabapentin, phenytoin, or carbamazepine) have some success in treating central pain. They are often used in combination with antidepressants. Neuroleptics show some success. Steroids are another drug that provides pain relief for some individuals.