Pain Management in Spinal Cord Injury
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Pain[edit | edit source]
According to the International Association for the study of Pain (IASP), pain can be defined as "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,”[1]
The prevalence of chronic pain after spinal cord injury varies from 34-90 % and among them 2/3rd of the patient suffer from chronic pain. [2]
Classification of pain[edit | edit source]
According to the International Spinal Cord Injury Pain Classification (ISCIPC), pain in Spinal Cord Injury (SCI) can be systematically classified into three tiers[3]:
- The first tier (Tier 1) is classifying pain as nociceptive pain, neuropathic pain, other pain, and unknown pain.
- The second tier (Tier 2) classifies various subtypes of pain under the category neuropathic and nociceptive pain.
- The third tier (Tier 3) specifies the primary pain source at the organ level as well as the pathology if either is known. This tier also includes the pain or syndromes which do not fulfill the criteria for nociceptive or neuropathic pain.
Nociceptive pain[edit | edit source]
Nociceptive pain is those arriving from a noxious stimulus through nociceptors (peripheral nerve endings or sensory receptors). Nociceptive pain can be further classified as musculoskeletal pain, visceral pain, and other types of pain.[3]
Musculoskeletal pain can be defined as pain occurring in parts of the body with preserved sensation and that is due to nociceptors within musculoskeletal structures(muscles, tensors, lig, joints, bones). Musculoskeletal pain can occur below the Neurological Level of Injury (NLI). Musculoskeletal pain can be characterized by one or more of the following features[3]:
- Pain intensity is affected by the movement or change in position
- On palpation, the musculoskeletal structures affected are tender
- Pain presentation matches with the imaging findings
- Endorsement of pain descriptors "dull" or "aching"
- Improvement in pain intensity from the use of anti-inflammatory or opioid medications
Note: If the pain is located below the neurological level and there is the failure of pain response to treatment and evidence shows no musculoskeletal pathology, it can be indicative of neuropathic pain.[3]
Example of musculoskeletal pain includes pain occurring from joint arthritis, fracture pain,muscle and tendon injury, muscle spasms.[3]
Visceral pain is pain generated in visceral structures located usually in the thorax, abdomen, and pelvis. The presence of visceral pain can be characterized by one or more of the following features[3]:
- Temporal relationship of food intake or visceral functions (for example constipation)
- Tenderness present over the visceral organ during palpation
- Pain presentation matches with the imaging findings
- Endorsement of one or more of the following pain descriptors"cramping", "dull", or "tender"
- Associated nausea and vomiting
An example includes pain resulting from constipation, urinary tract infection, ureteral calculus, bowel impaction, cholecystitis and myocardial infarction.[3]
Other pain (nociceptive pain)refers to nociceptive pain other than the musculoskeletal or visceral type of pain. These pains may be indirectly linked with the SCI or may be unrelated to SCI. Example of the pain includes pain from pressure sores, autonomic dysreflexia, migraine.[3]
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References[edit | edit source]
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- ↑ IASP Announces Revised Definition of Pain.Publication and News.Jul 16,2020.(cited: 12/6/2020) Available from: https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=10475
- ↑ Middleton J, Siddall P, Nicholson Perry K. Managing Pain for adults with spinal cord injury. Rural Spinal Cord Injury Project. 2002 Jun.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Bryce TN, Biering-Sørensen F, Finnerup NB, Cardenas DD, Defrin R, Lundeberg T, Norrbrink C, Richards JS, Siddall P, Stripling T, Treede RD. International spinal cord injury pain classification: part I. Background and description. Spinal cord. 2012 Jun;50(6):413-7.
