Chapter 4 - Methods for treating pain and painful syndromes in spinal cord injury: Medications, therapies, interventions, and neuromodulation

Abstract

Up to 80% of individuals with spinal cord injury (SCI) live with chronic pain that limits function, decreases quality of life, and leads to significant psychological impairment in most. Chronic pain after SCI is primarily neuropathic, although shoulder pain is an especially common nociceptive pain generator in wheelchair users. The mechanism of neuropathic pain after SCI is not fully elucidated, but likely is a unique process compared to neuropathic pain from peripheral nerve injury and involves disruption of supraspinal inhibitory centers and neuroinflammation at the site of injury. Neuropathic pain after SCI is often treatment resistant, although membrane-stabilizing agents and antiepileptic medications seem to be most helpful. Treating nociceptive pain in SCI as you would in the able-bodied (AB) population is an appropriate approach. Neuromodulation technique such as spinal cord stimulation (SCS) is an interesting treatment method in this population but still needs more research.