Spinal cord injury pain

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
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
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.

Causes

Injury to the spinal cord.

Risk Factors

Spinal cord injury

Symptoms

Spinal cord injury pain could worsen with the following factors:

  • broken bones or sore joints and muscles resulting from the accident
  • smoking
  • being tired
  • changes in weather
  • being emotionally upset
  • stress
Diagnosis

Research on pain following spinal cord injury is very complicated. Not only are there several types of pain, but people can also describe the same type of pain in different ways. Plus, individuals with SCI can feel pain in areas where there is no damage to the body. You may have severe pain at times and little or no pain at other times. It may change if the weather changes, if you smoke, if you are tired or emotionally upset, or if you have problems with your bowel, bladder or skin. These are only some of the factors that make it very difficult for doctors and researchers to diagnose, classify and treat pain.

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.

Narcotics:
Narcotics are generally not helpful for the long-term management of chronic SCI pain. Methadone is the preferred narcotic used in treating chronic pain. Some problems in using narcotics are developing a tolerance to the drug and experiencing withdrawal symptoms after you stop taking the drug.
Remember, alcohol is not a medication. It is not helpful and can lead to alcohol abuse and other serious problems.

Electrical Stimulation
Transcutaneous electrical nerve stimulation, called TENS, has, in some, provided relief from SCI pain. This technique involves placing electrodes on the surface of your skin and sending low levels of electrical current into your body. Doctors and therapists often use TENS first because the risks are low.

Nerve Blocks and Surgery
Nerve blocks refer to a drug being injected directly into the skin or spine. This method reduces the side effects of taking narcotics orally and the pain relief lasts longer. Another way to give the drug is using a surgically implanted pump. Doctors often use these treatments first because the risks are lower than with neurosurgery. The treatment method using the implanted pump is reversible.

Neurosurgical procedures are another option available for reducing pain in some individuals. These may involve cutting or destroying parts of the spinal cord or nerve roots thought to be the source of pain. One such procedure showing limited success is the dorsal root entry zone, also known as the "DREZ procedure". There are risks involved with this method, such as loss of bowel, bladder, sexual, and other functions. This surgery is a last resort and meant for extreme cases, since it is not reversible.

Other Treatment Approaches
While medical and surgical procedures for managing chronic pain are important, psychological approaches to coping with pain are as important. A major difference is that medical/surgical procedures are more passive. You allow professionals to do something to you to reduce your pain. With psychological approaches, you are an active participant.
Distraction is one of the best methods for coping with chronic pain. Keeping yourself busy in enjoyable and meaningful activities, whether recreation, work or volunteer activities, is most important. Inactivity and boredom allow you to focus more on your pain.

Depression can accompany pain, as well as result from everyday living problems or coping with a spinal cord injury. Depression can magnify the pain experience and result in social isolation. Depression is best treated through counseling, either with professionals or peer counselors. Severe depression may require medication or other treatment. Successful treatment of depression can improve your ability to cope with chronic pain.

Stress can magnify pain. You can learn to manage stress more effectively through counseling. How you think about your pain may affect how you cope with it. This can change your entire lifestyle. You want to decrease your pain so you may safely participate in as many activities as possible. Consult with your doctor to find out the type and cause of your pain. Ask what you can and what you cannot do. If you limit your activities, it may only make things worse.

Family counseling can also be helpful. Family members may not understand your pain. This can make them overprotective, or resent your use of medications, etc. Your pain can become a family concern. Education and counseling can be helpful to you and your family.

Prevention

The following could reduce spinal cord injury pain if you have spinal cord injury:

  • Quit smoking
  • A good night sleep
  • Distraction - Keeping yourself busy in enjoyable and meaningful activities, whether recreation, work or volunteer activities, is most important. Inactivity and boredom allow you to focus more on your pain.

Resources

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Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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