Pain after spinal cord injury

What is pain after spinal cord injury? 

There are various types of pain following a spinal cord injury.

Acute pain is a warning signal from the body that indicates impending or existing tissue damage. It fulfills a protective function - a popular example is pulling your hand away from a hot stove due to acute pain. If the spinal cord injury has occurred because of an accident, for example, it is usually associated with acute pain. It can also occur following surgery, which is often required as part of the acute treatment of a spinal cord injury.

Chronic pain lasts for at least several months, even if the underlying cause is no longer apparent, and has no function for the body. Its development is attributed to what is known as “pain memory”. This term describes a hypersensitivity of the nerve cells that process pain stimuli, which can develop with long-lasting pain and result in a pathologically exaggerated perception of pain. Up to 94% of patients with spinal cord syndrome experience chronic pain.

Why does pain often occur after a spinal cord injury?

In the case of traumatic spinal cord injury, damage also occurs to tissues that are not part of the nervous system, such as skin, muscles or bones, which causes nociceptive pain. Nociceptive means that the pain is due to the activation of pain sensors in response to general tissue damage, without injury to sensory nerve cells. Nociceptive pain can also occur as a complication of paralysis, for example, due to poor posture, contractures, or pressure sores.

Additionally, spinal cord injury results in damage to nerve cells. Injuries to the sensory nervous system can lead to a specific form of pain known as neuropathic pain. Unlike nociceptive pain, neuropathic pain can manifest in several ways, including:

• dysesthesia (unpleasant sensation that can occur spontaneously or provoked by a stimulus)

• hyperalgesia (increased perception of a pain-inducing stimulus)

• allodynia (painful sensation of a normally non-painful stimulus, e.g. a light touch)

• anaesthesia dolorosa (sensation of pain in an area that is numb due to nerve damage)

How is pain diagnosed after spinal cord injury? 

The patient's subjective report is the most important tool in the diagnosis of pain disorders. As chronic pain is complex and is influenced by physical, psychological and social factors, all these influences and possible accompanying conditions such as anxiety disorders or depression are recorded in a comprehensive patient history assessment. Other anamnestic instruments such as questionnaires, pain scales and pain diaries are also used.

As nociceptive pain is sometimes treated differently to neuropathic pain, this differentiation presents a particular diagnostic challenge. In areas of the body where nociceptive pain perception is no longer possible due to nerve damage, any existing pain must be neuropathic. Where there has been no injury to sensory nerve cells, pain is exclusively nociceptive. However, in regions with sensory deficits due to only partial disruption of the sensory pathways, both types of pain can occur, even simultaneously.

The following criteria may indicate that pain sensations are neuropathic in nature:

• no other identifiable cause

• no dependence on movement

• onset within one year of spinal cord injury

• sensitivity changes in the affected area (these are determined by a neurological examination)

• certain pain characteristics, e.g. burning, tingling, electrifying

If the pain in question is or is likely to be acute nociceptive pain, further examinations such as a physical examination, ultrasound, X-ray, CT or MRI must usually be carried out in order to determine the cause of the pain and to be able to treat it.

In cases of suspected neuropathic pain, electrophysiological examinations, in which an electrical potential is triggered at a nerve cell and the conductivity of the nerve pathways is measured, can be used to assess the function of the sensory nerve pathways.

What treatment options are available?

Nociceptive pain can be treated by eliminating the cause, provided it is not chronic. For instance, if a vertebral body fracture is surgically stabilized and can heal properly, the acute pain subsides and eventually disappears completely. Non-opioid analgesics such as paracetamol or ibuprofen, as well as opioids, which are stronger painkillers with a more severe side effects profile, are used as symptomatic therapy.

Neuropathic pain can only be treated symptomatically, as the nerve lesion cannot usually be cured. Most painkillers used for nociceptive pain, however, are not effective for this type of pain. Therefore, other medications such as anti-convulsants and tricyclic antidepressants provide relief.

For chronic pain of any kind, physiotherapy, psychotherapy and occupational therapy, as well as patient education and physical measures can be helpful.

How to deal with pain in everyday life after spinal cord injury and what tips are there for pain relief?

To help prevent some of the pain that can occur after a spinal cord injury, it is important to counteract muscle atrophy, shortening, and weakening from the outset. Mobilization after a spinal cord injury begins with physiotherapy in the hospital and should be continued by the patient at home. Both neuropathic and chronic nociceptive pain can often be alleviated through moderate physical activity, stretching exercises, massages, heat therapy, relaxation techniques, mirror therapy, and other therapies that can also be performed at home, although the effectiveness varies from person to person. In pain management treatment, patients should test different strategies for coping with and alleviating their pain to identify the methods that work best for them and learn how to apply them at home.

Which doctors & clinics are specialists in pain therapy for spinal cord injury?

Spinal cord injury is a neurological condition, which means that neurologists who have experience in treating the condition are also experienced in dealing with its various symptoms, including pain. Doctors who have completed additional training in specialized pain therapy can be consulted specifically for the treatment of chronic pain. This requires a specialist qualification in an area of patient care, as well as a course and year of special training in the field of pain medicine.

In clinics that specialize in the treatment of people with spinal cord injuries, various specialist areas work closely together to provide optimal care.

Anyone in need of a doctor would expect the best possible medical care for themselves. Therefore, patients are looking for the most suitable clinic for their needs. Since this is not an objective decision and a respectable doctor would refrain from claiming to be the best, patients must trust the experience of a doctor.

We can help you find an appropriate expert for your condition. All the doctors and clinics listed have undergone extensive review and have been verified by us for their outstanding expertise in the field of pain after spinal cord injury. They are looking forward to and are ready to address your questions and treatment requests.