Nerve Pain After a Spinal Cord Injury
Nerve (or neuropathic) pain is the most common type after SCI. People may describe it as a burning, squeezing, aching, or tight pain.
Pain may occur as a band around the level of the SCI or affect the whole body below the SCI.
Nerve pain is often hard to treat, mainly when it occurs at the level of the injury.
There are medications that doctors can prescribe to treat nerve pain. Sometimes, they can implant a drug pump to help control severe pain.
What causes nerve pain after an SCI?
People with an SCI sometimes feel nerve pain in parts of their body that technically have no feeling.
This is because the damaged nerves affected by the SCI still send signals to the brain. And the brain falsely translates this as pain.
Musculoskeletal Pain After an SCI
Problems in the bones, muscles, ligaments, or tendons can cause pain. People with SCI often have musculoskeletal pain above the level of the injury.
Increased use of the neck or arms can cause this pain and may get worse over time as people get older.
Common sites for bone, muscle, joint, and tissue pain include the:
Doctors often use a mix of medications, therapy, and equipment to treat musculoskeletal pain.
What causes bone, muscle, joint, and soft tissue pain after an SCI?
- Pain in the upper limbs. Transferring weight and pushing a wheelchair can lead to overusing muscles in the shoulders, elbows, and hands. Using computer devices to communicate or move can also cause pain in the hands and arms.
- Back or neck pain. Spinal fusion surgery after an SCI may increase motion above or below where the fusion happened. This increased motion can cause pain near the fusion site. Using chin or mouth joysticks can also cause neck pain over time.
- Pain from muscle spasms. An SCI interrupts signal flow between the spinal cord's nerves and the brain. Signals are "rerouted" to motor cells in the spinal cord, which causes spasms. These uncontrolled muscle contractions can be painful, especially when your muscles and joints become strained.
Visceral Pain After an SCI
Visceral pain describes any pain that comes from internal organs around the belly. It can feel like cramps or aches.
What causes stomach pain after an SCI?
Common sources of stomach pain for people with SCI include:
- Constipation.
- Ulcers.
- Gallbladder disease.
- Appendicitis.
SCI Pain Treatment and Management
It's vital to remember that there can be many different causes of SCI pain.
Some types of pain may be sudden or acute. Other forms may be chronic.
In either case, the SCI experts at the UPMC Rehabilitation Institute tailor a pain management plan for each person.
If you have any problems with pain, it's crucial that your SCI doctor assesses you.
In some cases, they may refer you to a pain management specialist to get the best control of your SCI pain.
How do you manage and treat SCI pain?
Many non-invasive treatments can help, including:
- Physical therapy. Strengthening weak areas can help support muscles and reduce pain. Stretching and other range-of-motion exercises can also provide relief, as can massage.
- Modifying activity or equipment. Learning new transfer techniques or ways to relieve pressure can reduce muscle and joint pain. You may also need changes to your mobility equipment, including wheelchairs or sliding boards.
- TENS unit. Transcutaneous electrical nerve stimulation, or TENS, is a small, portable unit. It sends electrical signals into the sensory part of your spinal cord and then up to the brain. In essence, it tricks your brain, so it doesn't recognize the pain.
- Acupuncture. Some people with SCI respond well to acupuncture, which uses tiny needles to affect the body's pain control system.
- Relaxation and self-hypnosis techniques. Learning these techniques may help reduce SCI pain and tense muscles.
- Psychotherapy. Trained therapists can help people with SCI confront anxiety and think differently about pain.
Surgical treatments also help relieve pain, often through implantable devices.
Common medications to treat SCI pain
Talk to your doctor about what medicine is right for you. They vary in effectiveness, depending on your pain level and how your body responds to certain drugs.
Common pain medicines for SCI pain include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen, aspirin, and naproxen are generally safe. But taking them for too long can affect your kidney and liver.
- Anti-seizure drugs. Drugs like gabapentin can help with nerve pain from an SCI.
- Muscle relaxants. Diazepam, baclofen, and tizanidine help with muscle and spasm pain. You can take them by mouth or receive them from an implanted pump directly to the spinal cord.
- Anti-depressants. Selective serotonin-norepinephrine reuptake inhibitors (SSNRIs) can help with depression and nerve pain.
- Narcotics. Drugs such as codeine, morphine, oxycodone, and hydrocodone provide pain relief but often aren't a first-line treatment. They can have side effects and can be habit-forming. It's vital to talk to your doctor about these medications.
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