Topic Overview

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 doctor. You need to know the type of pain and its cause to manage it. And pain can signal a more serious problem.

• Complementary therapies may reduce pain. They may also help you cope with stress and improve your emotional and physical well-being. These therapies include:
  • Acupuncture, a treatment based on traditional Chinese medicine. Acupuncture involves putting very thin needles into the skin at certain points on the body.
  • Biofeedback, a method of consciously controlling something normally controlled automatically by the body, such as skin temperature.
  • Guided imagery, a series of thoughts and suggestions that direct a person's imagination toward a relaxed, focused state.
  • Hypnosis, a state of focused concentration. In hypnosis, a person becomes less aware of his or her surroundings. Some people learn to manage pain by concentrating in this way.
  • Yoga, which uses meditation and exercise. Yoga helps you improve your breathing, be more flexible, reduce stress, and stay healthy.
• Transcutaneous electrical nerve stimulation (TENS) applies brief pulses of electricity to nerve endings in the skin. This can relieve chronic pain.
• Counseling (such as cognitive-behavioral therapy) focuses on your mental health and conditions such as stress and depression. These can happen along with chronic pain and make it worse. To recover from your chronic pain, it is important to take care of your emotional health and your physical health.
• Several classes of medicines are used for neuropathic pain. These include anticonvulsants, such as gabapentin; tricyclic antidepressants, such as amitriptyline; and opioid analgesics, such as morphine.
  • Segmental pain may also be treated by injecting an anesthetic medicine 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).