Spinal cord injuries and chronic pain is one of the most significant, challenging and perhaps the most difficult thing to cope with. Medical advances have improved the health and life expectancy of many people with this suffering. Effective chronic pain management is usually only achieved by a team approach with a team of various professionals ranging from doctors to therapists to acupuncturists.
Chronic pain after spinal cord injury (SCI) is known as central neuropathic pain, meaning that it originates in the central nervous system, usually below the level of injury. Because of this, the pain management is a program of multiple treatments, such as conservative medical treatment and physical therapy, procedures designed to stop the pain from traveling through the nervous system and narcotics.
How Spinal Cord Injuries Chronic Pain Feels
The chronic pain felt with a spinal cord injury has been described as:
The pain is felt long after the acute injury has occurred. The pain may be caused by an impairment of the sensory input from the peripheral nervous system. It may also be the result of abnormal firing of the nerves or hypersensitive neurons. There are numerous theories as to what is the exact cause of SCI chronic pain but there is no proven, definitive cause to date.
Chronic Pain Treatment in Spinal Cord Injuries
Because the severity of pain, spinal cord injuries can be so complex, there is no one treatment that is effective in all cases. The pain management may begin with conservative pain meds, muscle relaxants and other drugs. Medical and physical therapy is often part of the pain treatment.
If pain remains uncontrolled, then the next step may be the selective destruction of sensory nerves that deliver the pain to the area or that are responsible for the pain sensation. Procedures of this nature are called neuro-ablative procedures and should only be done by a pain specialist.
Finally, if the pain continues, then narcotics are prescribed. Because of their addictive nature and because the drugs affect and can impair the whole person as they provide pain relief, narcotics are the last pain treatment.
Chronic pain SCI is resistant to treatment and difficult to manage non-surgically. However, studies still indicate that it is best to start conservatively with the treatment options and then, only if there is no relief, slowly move into the surgical options. A small number of spinal cord injury victims will experience satisfactory relief with conservative measures.
In addition to the SCI patient, the pain management team consists of:
- Pain management physicians
- Rehabilitation nursing staff
- Physical, occupation and recreational therapists
In summary, the treatment options for spinal cord injury chronic pain can be categorized as:
- General health promotion
- Relief from exacerbating factors
- Non-narcotic pharmacologic treatment
- Physical treatments
- Surgical treatments
- Narcotic pharmacologic
Exacerbating Factors of Spinal Cord Injuries and Severe Pain
There are times when SCI chronic pain may increase after being controlled for a time. There are certain factors known to exacerbate chronic SCI pain. Often it is an infection somewhere in the body, such as the respiratory system or bladder. General health management is necessary in the control of chronic pain in the spinal cord injuries patient. This includes control of stress, anxiety and depression.