Medication Information

Pain and pain management

Pain after SCI/D

Pain is very common following SCI/D Spinal cord injury or dysfunction. . The pain that occurs after SCI/D Spinal cord injury or dysfunction. can vary between individuals based on where it is felt, how it feels, how people respond to treatment, and how much it can affect someone’s quality of life.

Pain can be acute or chronic.

• Acute pain Pain that is sudden in onset and lasts for a short duration. Caused by tissue damage or injury. lasts less than 12 weeks
• Chronic pain Pain that lasts longer than 3 months and continues after an injury or illness. lasts more than 12 weeks, without an ongoing injury

People can experience more than one type of pain after SCI/D Spinal cord injury or dysfunction. . There are three categories of pain following SCI/D Spinal cord injury or dysfunction. : (1) nociceptive pain A type of pain that is caused by tissue damage or injury like pain from a paper cut or a broken bone. ; (2) neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). ; and (3) other pain.

1. Nociceptive Pain

Nociceptive pain A type of pain that is caused by tissue damage or injury like pain from a paper cut or a broken bone. occurs from the activation of nerve endings or receptors (nociceptors).

This type of pain is often described as dull, cramping, tender, or aching. It is often due to the initial injury, overuse of muscles or joints, spasms, bone fractures, or contractures.

Nociceptive pain A type of pain that is caused by tissue damage or injury like pain from a paper cut or a broken bone. is most often categorized as musculoskeletal pain or visceral pain Pain coming from the internal organs (e.g., stomach or intestines). Described as a deep, dull ache. .

a. Musculoskeletal Pain: Musculoskeletal pain affects the bones, muscles, joints, tendons, and/or ligaments. Some examples include:

• Arthritis
• Fracture
• Muscle spasms
• Tendonitis

b. Visceral Pain Pain coming from the internal organs (e.g., stomach or intestines). Described as a deep, dull ache. : Visceral pain Pain coming from the internal organs (e.g., stomach or intestines). Described as a deep, dull ache. stems from internal organs, usually in the thorax, abdomen, or pelvis. Some examples include:

• Heart attack
• Constipation
• Urinary tract infections

c. Other Nociceptive Pain A type of pain that is caused by tissue damage or injury like pain from a paper cut or a broken bone. : Other nociceptive pain A type of pain that is caused by tissue damage or injury like pain from a paper cut or a broken bone. refers to nociceptive pain A type of pain that is caused by tissue damage or injury like pain from a paper cut or a broken bone. that is not musculoskeletal or visceral pain Pain coming from the internal organs (e.g., stomach or intestines). Described as a deep, dull ache. . Some examples include:

• Headaches and migraines
• Autonomic dysreflexia Health condition that affects individuals with a spinal cord injury at or above the T6 level. This syndrome involves an overreaction of the nervous system and can cause high blood pressure resulting in a headache, sweating, blotchy skin, and bladder and bowel problems.
• Pressure sores

Management of Nociceptive Pain

Nociceptive pain A type of pain that is caused by tissue damage or injury like pain from a paper cut or a broken bone. is often managed with non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, cannabinoids, opioids Class of pain-relieving medication that work by blocking pain signals in the brain. Examples include drugs like morphine, oxycodone, and fentanyl. , local and topical anesthetics (e.g., licodaine), and botulinum toxin (if the pain is associated with spasticity Condition in which muscles become stiff, tight, and difficult to control. ).

2. Neuropathic Pain

Neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). is caused by disease or injury to the nervous system.

This type of pain is often described as:

• Sharp
• Burning
• Tingling
• Shooting
• Pins and needles
• Squeezing
• Electric shock

Neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). is categorized as at-level SCI pain, below-level SCI pain, or other.

1. At-level SCI Pain: At-level SCI pain refers to neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). that occurs around the level of injury to the spinal cord.
2. Below-level SCI Pain: Below-level SCI pain refers to neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). that occurs below the level of injury to the spinal cord (may include phantom pain).
3. Other Neuropathic Pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). : Neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). that occurs at, or below, the level of injury, but is not related to the SCI/D Spinal cord injury or dysfunction. . For example, pain associated with diabetic neuropathy or carpal tunnel syndrome.

Management of Neuropathic Pain

Based on the CanPain SCI Clinical Practice Guidelines for the management of neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). after SCI/D Spinal cord injury or dysfunction. , the following treatments are recommended:

First-line treatments for the management of neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). include pregabalin (Lyrica), gabapentin (Neurontin), and amitriptyline (Elavil). After these first-line treatments, there are second, third, and fourth-line treatments that can be used in any order (do not have to go in order from second to fourth).

Second-line treatments for the management of neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). include oxcarbazepine, tramadol, and lamotrigine.

Third-line treatments for the management of neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). include botulinum toxin A, transcranial direct current stimulation, and combined visual illusion.

Fourth-line treatments for the management of neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). include cannabinoids, transcutaneous electrical nerve stimulation, oxycodone, and a dorsal root entry zone (DREZ) procedure.

The following medications are not recommended for the management of neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). : levetiracetam and mexiletine. These medications are not recommended because there were no significant differences between them and the placebo in reducing neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). intensity.

3. Other Pain

Other pain is pain that cannot be attributed to nociceptive or neuropathic pain A type of pain caused by nerve damage or dysfunction. It can feel like burning, tingling, or shooting sensations and is often chronic (long-lasting). . Some examples include fibromyalgia and irritable bowel syndrome.

Alternative Pain Management Options

Alternative treatments Healthcare practices used with or instead of medical treatments. For example, these treatments may include therapies such as acupuncture, chiropractic care, and herbal medicine. can also be used in combination with medications. Some non-medication alternatives for these different types of pain include:

• Acupuncture
• Electrical stimulation/Transcutaneous Electrical Nerve Stimulation (TENS)
• Exercise and strength training
• Heat
• Massage
• Mindfulness and meditation
• Pain education
• Peer support
• Physical therapy or rehabilitation Process of assessment, treatment and management to help a person who has suffered an illness or injury restore lost skills and improve.
• Psychological treatment (e.g., cognitive behaviour training A form of psychological treatment where one works with a mental health counsellor in a structured way to treat mental health disorders. , acceptance commitment therapy)

Pain Triggers

There are factors that can worsen pain. For example:

• Remaining in one position for a long period of time without adjusting body position (e.g., prolonged sitting)
• Infections (e.g., urinary tract infection An infection in any part of the urinary system (including the bladder, kidneys, ureters, urethra). Symptoms include pain or burning during urination, frequent urination, and cloudy or bloody urine. )
• Fatigue
• Muscle spasms
• Weather
• Sudden movements
• Negative mood (e.g., feeling anxious or depressed)
• Constipation
• Full bladder
• Physical activity (exercise may improve or worsen the pain – depends on the person)

It is important to be aware of the situations that may trigger your pain so you can try to prevent or treat them. Overall, pain can affect people differently and there are multiple pain management strategies available. The goal is to find a pain management approach that works well for you to reduce your pain and its effect on your daily activities.

Talk to your healthcare provider about:

• Where the pain is felt
• What the pain feels like
• Any impacts pain has on your day-to-day life
• Your preference for pain management (e.g., medications, alternative therapies)

For more information check out:

• SeePain Module 1
• SeePain Module 2
• https://community.scireproject.com/topic/pain/
• https://portal.poweroverpain.ca/about/about-pop-portal