A Primary Care Provider’s Guide to Pain After Spinal Cord Injury: Screening and Management

Abstract

Individuals with spinal cord injury (SCI) often experience chronic pain as a secondary complication. It can significantly impair mental health, sleep, mood, and overall quality of life. It is important for providers within a primary care setting to recognize the different types of pain such as nociceptive and neuropathic. Various assessment tools are available to guide proper classification and subsequent management. Providers need to have a good knowledge base, structure, and patient focus when managing care. Nonpharmacological interventions are just as important and should be explored prior to or along with pharmacological interventions. Treatment modalities such as physical therapy, exercise, acupuncture, and cognitive behavioral therapy should be tailored to the individual to the greatest extent possible. Gabapentin, pregabalin, and amitriptyline have been studied extensively and are the first-line pharmacological agents for neuropathic pain. It is important to involve patients as equal stakeholders in any pain intervention with adequate lifelong follow-up. The aim of this article is to offer an overview of pain assessment, information, patient interaction, and treatment options available. Although chronic pain has remained difficult to treat successfully, primary care providers can play an integral role in delivering evidence-based and patient-centered care for managing chronic pain among individuals with SCI.

The presence of pain in community-dwelling South African manual wheelchair users with spinal cord injury

“…Our findings of high rate of pain are similar to those reported by Madasa et al (2020) who found that 80% of their participants in Cape Town reported the presence of pain after SCI. Our findings are consistent with global literature in that neuropathic pain is the most common type of pain; in the lower limbs and 'burning' is one of the major symptoms (Adriansenn et al 2013;Gustin et al 2014;Ullrich et al 2008;Varghese et al 2020). Although the lower limbs were the most common location of pain in our study, we would like to emphasise that pain is common throughout the body.…”

“…There is a high prevalence of secondary health conditions (SHCs) in community-dwelling people with spinal cord injury (SCI), with chronic pain being among the leading SHCs (Brinkhof et al 2016 ; Piatt et al 2016 ). The prevalence of SCI-related pain is estimated to be twice that of the general population (Varghese et al 2020 ), with one-third of affected people with SCI (PWSCI) experiencing severe pain (Müller et al 2016 ). The actual prevalence rate of SCI-related pain is highly variable, with reported rates between 26% and 96% (Cohen et al 2018 ) because of the varying types of pain, as well as other factors such as injury profiles.…”

“…Musculoskeletal pain is the most common nociceptive pain with 59% of PWSCI reporting this and the pain generally occurs in areas with preserved sensation (i.e. above the level of injury) (Finnerup 2013 ; Varghese et al 2020 ). The behaviour of musculoskeletal pain is usually described as dull, sore, throbbing, tender, aching and cramping (Stanos et al 2016 ; Varghese et al 2020 ).…”

“…above the level of injury) (Finnerup 2013 ; Varghese et al 2020 ). The behaviour of musculoskeletal pain is usually described as dull, sore, throbbing, tender, aching and cramping (Stanos et al 2016 ; Varghese et al 2020 ). Visceral pain is only present in a minority of PWSCI within the first 5–10 years following injury and can be difficult to treat (Finnerup 2013 ).…”

“…Visceral pain is only present in a minority of PWSCI within the first 5–10 years following injury and can be difficult to treat (Finnerup 2013 ). Visceral pain is often atypical because of the sensory fallouts after SCI, resulting in the affected individuals having an altered experience of pain (Varghese et al 2020 ).…”