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Objectives

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OBJECTIVES

After reading this chapter, the reader will be able to:

  • Understand the clinical characteristics and classifications of the various chronic pain types associated with spinal cord injury (SCI)

  • Understand ideas concerning the underlying pathophysiological mechanisms of chronic pain associated with SCI

  • Understand the role of common psychosocial factors involved in the experience of chronic pain associated with SCI

  • Understand the various components of a comprehensive assessment of chronic pain associated with SCI

  • Understand the role of recent clinical trials in providing guidelines for clinical management of chronic pain associated with SCI

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Introduction

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Prevalence of Pain

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In the aftermath of a spinal cord injury (SCI), chronic pain is unfortunately a common and often severe and persistent consequence.1,2,3,4,5,6,7 Moreover, pain commonly interferes with both routine daily activities and physical functioning, including sleep,8,9,10,11 making chronic pain one of the major contributors to reduced quality of life after SCI.12,13,14 In addition to a background of spontaneous chronic pain, persons with SCI also frequently experience pain exacerbation induced by a variety of common emotional as well as physical stimuli, such as negative mood, fatigue, prolonged sitting, cold weather, muscle spasms, constipation, etc.15

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Persons who suffer from pain associated with SCI rarely report complete remission of their pain. In a study by Störmer et al,16 only 5.8% of those who suffered from chronic pain or other distressing sensory abnormalities following SCI completely recovered spontaneously or due to a treatment. Similarly, several recent studies have confirmed the refractory nature of SCI.17,18,19 Thus, pain continues to be a significant problem for large numbers of individuals living with a SCI despite the availability of treatments that have proven effective in other chronic pain populations.

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Pain Classification

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The chronic pain conditions that develop following a SCI are heterogeneous,20,21,22,23 and most persons experience more than one type of pain simultaneously.4,6,24 This heterogeneity complicates both the diagnosis and the subsequent treatment of pain and has therefore prompted the development of special pain classifications, or taxonomies, for SCI-related pain. The development of a standard mechanism-based taxonomy for SCI-related pain is an important step toward the development of treatment strategies that are tailored to specific mechanisms of pain.23,25,26 A standardized taxonomy would facilitate comparisons among research studies and communication among professionals involved in the care of patients with SCI. Moreover, a consistent classification system for SCI-related pain would also improve the interpretation and translation of basic research findings by facilitating the development of clinically relevant animal models of pain. However, a taxonomy based exclusively on pathophysiological mechanisms is not realistic until the relationship between specific ...

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