Chronic pain is an important problem following spinal cord injury (SCI) and is a major impediment to eective rehabilitation. The reported prevalence of chronic SCI pain is variable but averages 65% with around one third of these people rating their pain as severe. The mechanisms responsible for the presence of pain are poorly understood. However, evidence from clinical observations and the use of animal models of SCI pain suggests that a number of processes may be important. These include functional and structural plastic changes in the central nervous system following injury, with changes in receptor function and loss of normal inhibition resulting in an increased neuronal excitability. A number of speci®c types of SCI pain can be distinguished based on descriptors, location and response to treatment. Nociceptive pain can arise from musculoskeletal structures and viscera and neuropathic pain can arise from spinal cord and nerve damage. The role of psychological and environmental factors also needs to be considered. Accurate identi®cation of these pain types will help in selecting appropriate treatment approaches. Current treatments employ a variety of pharmacological, surgical, physical and psychological approaches. However, evidence for many of the treatments in use is still limited. It is hoped that future research will identify eective treatment strategies that accurately target speci®c mechanisms. Spinal Cord (2001) 39, 63 ± 73Keywords: spinal cord injuries; pain; neuropathic pain; paraplegia; tetraplegia Historical overviewChronic pain is a major problem in those who have sustained a spinal cord or cauda equina injury.1 These patients usually have devastating neurological de®cits. A signi®cant proportion also suers from chronic pain. Riddoch 2 addressed the problem of pain after SCI in his 1917 paper although Munro's classic paper on spinal cord injuries in 1943 did not even mention the issue of chronic pain.3 After WW II, Botterell et al. 4described chronic pain in 12/103 SCI patients and 11 of these 12 had cauda equina injuries. Kuhn 5 reported that 0.234% of the injuries in WW II involved the spinal cord and that 22.5% of 113 patients with SCI had chronic pain. Prevalence/incidenceSince then, there have been numerous reports regarding the incidence and prevalence of pain following SCI. In 1962, Kaplan 6 attempted to classify SCI pains and stated that 37% of 52 SCI patients had chronic pain 1 year after injury and this increased to 50% by 5 years after injury. Davis 7 reported an incidence of 27% in 471 SCI patients. Richards et al.8 claimed that 77% of 88 SCI patients had chronic pain and that psychosocial variables predicted about 1/2 of the variance. Woolsey 9 identi®ed less than a 20% incidence of chronic pain in a group of 100 SCI patients.A number of more recent studies have all contributed data on the incidence and prevalence of pain after SCI.10 ± 17 The methodology and the patient population being studied appear to greatly in¯uence the reported incidence of SCI pain but across studies it appears...

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