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) and
    tricyclic antidepressants (such as amitriptyline).

    • 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 baclofen and tizanidine (Zanaflex).

Related Information

Credits

ByHealthwise Staff
Primary Medical Reviewer Adam Husney, MD – Family Medicine
Martin J. Gabica, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Nancy Greenwald, MD – Physical Medicine and Rehabilitation

Current as ofOctober 9, 2017