Understanding therapies selected for managing pain associated with spinal cord injuries

Abstract

Pain is a common consequence in patients who are suffering from a spinal cord injury (SCI). Such pain affects nearly all aspects of life including mood, physical function, and social activities. Management of pain must be preceded with a thorough clinical examination which characterizes pain according to a classification scheme. The International Spinal Cord Injury Pain classification system divides pain into three tiers: according to type (nociceptive or neuropathic), according to subtype (localization of pain), and according to the source. Neuropathic pain is predominately treated with three different types of pharmaceutical therapies – antidepressants, anticonvulsants, and analgesics. Multiple studies have shown amitriptyline, gabapentin, and pregabalin as being the most efficacious. Nociceptive pain is mainly treated with analgesics and physiotherapy, often together. Moreover, spasticity associated with nociceptive pain is treated with antispasmodics and physiotherapy. Non-traditional means of therapy, specifically transcutaneous electrical nerve stimulation, have demonstrated a favourable effect on pain. Nevertheless, finding an optimal treatment remains difficult and largely empirical. A stronger understanding of the mechanisms behind each pain type is needed in order to provide therapies that are better suited at targeting the source of the pain while minimizing possible side effects often seen in the SCI population. An integrated approach that ine tunes the combination of pharmacological and nonpharmacological therapies is needed for optimal management in SCI pain.