In the Spotlight
Contributed by Philip Ullrich, Ph.D.
Pain is one of the most common and serious problems faced by persons with spinal cord injury (SCI). The majority of people with SCI experience numerous pain problems and for many their pain is severe enough to affect their daily activities. Finding methods for controlling pain and reducing the impact of pain on daily activities is a constant challenge for patients and healthcare providers.
There are two basic types of pain after SCI. The first is Musculoskeletal pain. It is caused by damage to muscle and bone. Typically it is related to activities such as wheelchair use or transferring between surfaces. This type of pain is often identified by location and how it is experienced. For example, aching pain in the shoulder might suggest musculoskeletal pain. The second basic type of pain is Neuropathic pain. This refers to pain caused by damage to the spinal cord. This type of pain might be described as "burning," or "tingling, pins-and-needles." Finding the cause of pain is critical because this may be a clue about what treatments are most helpful For example, providers might want to treat musculoskeletal pain through physical therapy and non-steroidal anti-inflammatory drugs. By contrast, neuropathic pain as a rule is treated with anticonvulsant medications such as gabapentin.
These methods often do not reduce the pain enough. This is due to the fact that pain is experienced as much more than sensory signals from damaged muscles or nerves. In addition to the sensory experience of pain, a person in pain is also likely to notice changes in thoughts, feelings, and behaviors. For example, when pain flares up, one might worry more, feel stressed or depressed, and choose to stay in bed all day. We have found that these reactions to pain can make pain worse. When pain treatments only deal with the sensory aspect of pain, the negative effects of mood, inactivity, and stress can continue to make pain worse. These effects can also limit how well pain medications work.
It may be helpful for you and your healthcare providers to think about how to reduce pain. Think about what you can do to limit the various ways that pain impacts your life. The challenge for the person with a stubborn pain problem is to be active, happy, and even relaxed, in spite of the pain. This is a hard job for anyone with pain. The first step is to work with your healthcare providers to identify some pain-related targets for treatment. For example you may want to work on improving your mood, becoming more active, or more relaxed. Pain problems are best managed by a healthcare team. This team should include physicians, nurses, occupational and physical therapists, social workers, and psychologists all working with you to manage pain and its affect on your life.
Pain is a complex experience that affects each person in a unique way. Therefore, it is best that you work with your healthcare providers to design a treatment plan that is made just for you. This plan should address your pain and the multiple ways that pain is impacting your life.
Study Suggests Improved Treatments for Neuropathic Pain (NIH)
Pain After Spinal Cord Injury (Spinal Cord Injury Information Network)
Northwest Regional Spinal cord Injury System (NIDRR)