Since pain can have so many different causes, there is no single way to treat it. You and your doctor may need to try a combination of medications, therapy and other treatments, including psychological treatments, and this may take some time to work out. Whats most important is to stick with it, remember that things will improve, and remain hopeful that pain after a SCI is manageable and a great life IS possible. This article canvasses the most common options people may utilise.
Pain is a serious problem for many people with spinal cord injuries (SCI). Pain after SCI can occur in parts of the body where there is normal sensation (feeling) as well as areas that have little or no feeling. The pain is very real and can have a negative impact on quality of life. A person in severe pain may have difficulty carrying out daily activities or participating in enjoyable pastimes.
The majority of people with SCI report that they have chronic pain. Chronic pain is pain that does not go away and instead lasts months to years. The cause of the pain may be unknown but is most often related to nerve damage from the SCI or musculoskeletal problems that arise in dealing with an SCI. The pain can come and go. Chronic pain is difficult to completely eliminate but often can be managed or reduced enough so that it doesn't overwhelm your life.
Chronic pain can cause or worsen psychological problems such as depression, anxiety and stress. This does not mean the pain is "all in your head," but rather that pain and distress can make each other worse.
Even though pain after SCI can be complicated and difficult to treat, there are many treatments available that can help. Understanding your pain, working with your doctor and being open to a variety of treatments will help you manage your pain and improve your quality of life.
Types of pain include:
- Neuropathic pain - caused by abnormal communication between the nerves that were damaged by your spinal cord injury and the brain
- Musculoskeletal pain - caused by problems in the muscles, joints or bones. It is a common problem for all people as they get older, including those with SCI. Musculoskeletal pain can be caused by injury, overuse or strain, arthritic changes, or wear and tear of the joints, often from wheelchair use (including inadequate support for sitting) and/or transfers. It usually gets worse with movement and better with rest.
- Visceral pain - is located in the abdomen (stomach and digestive area) and is often described as cramping and/or dull and aching. It can be caused by a medical problem related to having a SCI or form the result of medication used to help with other forms of pain (e.g. constipation from using medication to help with neuropathic pain).
- A further type of pain is called Referred pain. This can or may be felt in an area away from the injury site. It may result from irritation to a nerve branch or root and is perceived in the related innovated areas.
Physical treatments and interventions
- Activity modification for musculoskeletal pain. Changes in your mobility equipment (wheelchair, sliding board), your wheelchair pushing and transfer techniques, and in the way you do pressure reliefs can significantly decrease pain in your muscles and joints. Exercises that strengthen and balance your joints can also help reduce musculoskeletal pain.
- Physical therapy (physiotherapy or exercise-based programs, including Pilates) may be used to treat musculoskeletal pain. Stretching and range of motion exercises may help relieve pain associated with muscle tension. Exercises that strengthen weak muscles can restore balance in painful joints and reduce pain.
- Therapeutic massage may help relieve musculoskeletal pain due to muscle tightness and muscle imbalance.
- Acupuncture (or dry needling from a physiotherapist) can sometimes be used to treat musculoskeletal pain too. Tiny needles are inserted into the skin at specific points on the body. This method is thought to work by stimulating the body's pain control system or by blocking the flow of pain.
- Transcutaneous electrical nerve stimulation (TENS) is sometimes used to treat musculoskeletal pain too. With TENS, electrodes are placed on the surface of your skin and send low levels of electrical current into your body. The current blocks signals from the areas of nerve damage that are triggering a pain response.
Psychological treatments
We now know that people can learn to use psychological techniques to help them manage their pain better so it doesn't take over their lives. Psychologists or counsellors may help with a variety of techniques proven to be effective in reducing the intensity and impact of pain.
- Relaxation techniques and/or biofeedback designed to teach you how to reduce muscle pain tension and "mental tension" associated with pain can be helpful in self-management.
- Self-hypnosis training has proven helpful for reducing chronic pain in some individuals.
- Cognitive restructuring. Learning how to think differently about your pain and its effects can actually lead to changes in brain activity and, in turn, the experience of pain.
- Individual psychotherapy designed to help identify desired goals and increase pleasure and meaning in daily life can help reduce pain. Therapy can also help if there is a significant amount of anxiety associated with pain.
- Person-centred and acceptance therapies can help people adjust to living with pain too.
Using medications to help with pain
There are many medications to treat pain. All medications have possible side effects, some of which can be serious. Always discuss any need for medications as well as understand how they may help you, and any side effects, with your doctor. Likewise, if you are noticing a problem with a medication for pain, speak to your doctor as soon as possible. Pain medications may also alter how people react, perceive or function (e.g. affect the way you think, alertness, attention, etc). Be sure to understand dhow any medication(s) affect you firstly, so you stay as safe as possible.
Surgical Treatments
- Dorsal column stimulator is used to treat neuropathic pain due to nerve root damage. A high frequency, low intensity nerve stimulator is surgically placed in the spinal canal next to the spinal cord or nerve roots.
- Intrathecal pumps are used to treat neuropathic pain or muscle spasm-related pain. A pump containing medication is surgically placed under the skin in the abdomen. It delivers the medication directly to the spinal cord and nerve roots, as required. This option can reduce the need for regular needles, or tablets, if these don't work well for you. One benefit is that pumps deliver a smaller of medicine, more regularly, and therefore can help avoid problems and side effects.
Prevention and self-care
- Get treatment for medical problems. Overall health can have a big impact on pain. Urinary tract infections, bowel problems, skin problems, sleep problems and spasticity/dystonia can make pain worse or harder to treat. Keeping yourself as healthy as possible can help reduce pain.
- Try to get as much exercise as possible. Getting regular physical activity can reduce pain as well as improve mood and overall health. It can also be enjoyable and distract you from pain. Your health provider or therapist can help you choose physical activities that are safe and appropriate for you.
- Get treatment for depression. Depression can make pain worse, and constant pain can also trigger depression too. If you are feeling depressed, this is best treated through counselling and medication. Getting treatment for depression can help you cope with chronic pain and improve your quality of life, overall.
- Reduce stress. Stress can make pain worse or make the pain harder to cope with. You can learn to manage stress through counselling and learning techniques to help you reduce stress and tension, such as relaxation training, biofeedback and hypnosis. Exercise helps reduce stress.
- Distract yourself. Distraction is one of the best methods for coping with chronic pain. Participating in enjoyable and meaningful activities can help reduce pain and help you feel more in control of your life, especially when pain is at its worst. When you are bored and inactive, you tend to focus more on your pain, and this can make your pain feel worse. Work is also a great distraction because you are more focused on the task ay hand - staying meaningfully engaged with work is therefore really important too. If you can't do the job you used to because of a SCI, think about other ways you could engage with work (including volunteering in your local community).
- Keep a record. Everyone's pain is a little different. Keeping a record of what makes you feel better and what makes pain worse can provide some guiding posts for you and your treatment team. Understanding things that affect your pain will help you and your doctor to find effective ways to reduce your pain and gain the best relief possible. You may also find that a pain diary helps to idnetify pain triggers, or particular parts of your day when pain is either better or worse. All information is good information (important!) to help design the best individual management pathway for you.
Disclaimer: This article was written by a SchemeWise registered nurse and is intended to offer general advice on available options only. You must always consider your circumstances and medical advice / recommendation and follow that at all times.
