Pain is a common complication following a spinal cord injury (SCI), with studies reporting up to 80% of patients experiencing some sort of pain. Around 50% of people will experience neuropathic pain, which is caused by damage to the spinal cord. The brain still sends messages to the areas of the body affected by SCI but doesn’t receive a ‘normal’ response, with the messages that do get back to the brain being interpreted as pain.

Neuropathic pain is often described as feeling like a burning or electric sensation, it can be sharp and sudden or can be a constant ache. Treating or managing neuropathic pain can be extremely challenging following SCI, and it’s likely that those experiencing it will have to accept living with pain in some form.

Speak to a Pain Specialist

Getting an accurate pain diagnosis is vital in the management of neuropathic pain. It may be helpful to give clinicians a description of the location, intensity, duration and frequency of the pain, as well as anything that aggravates or relives it. Keeping a pain diary and a history of the pain (when it started, past treatments, circumstances, etc.) may help in relation to diagnosis and future treatment. 

Your GP will be able to refer you to a pain specialist, and the specialist spinal centres and neurological rehabilitation units will also be able to recommend someone you can talk to. 

Before starting any treatment, a thorough investigation into the causes of pain should be done, as things like inappropriate seating, transfer techniques or joint positions can be a root cause.

Despite neuropathic pain being difficult to manage, there are a number of treatments available to help, this guide outlines some of them.

Pharmacological Treatment

Neuropathic pain after SCI often emerges as a chronic condition and responds poorly to a single drug, however, a combination of treatments can be effective. Pharmacological treatment of neuropathic pain is generally a long-lasting process and both effects and side-effects of any drugs should be considered before starting. 

There are a number of antidepressants, antiepileptics, antispastics, opioids, anaesthetics and cannabis-based medications that have been the subject of studies into their effectiveness in managing neuropathic pain, however, these studies have usually involved small numbers of participants and the results are often inconclusive. 

Common drugs prescribed for neuropathic pain include – 

• Pregabalin
• Gabapentin
• Amitriptyline
• Ketamine
• Tramadol
• Baclofen
• Diazepam
• Morphine

It may be that any one drug may not have the desired impact on managing neuropathic pain, but rather a combination of treatments which eases suffering. As with all medications, the above all have reported side effects which should be considered before a course of treatment is started and regularly reviewed.

Multidisciplinary Approach

Alongside pharmacological treatment, a multidisciplinary approach involving cognitive behavioural therapy, and physical and occupational therapies can help pain management.

Cognitive Behavioural Therapy (CBT)

In conjunction with pharmacological treatment, or as an alternative, cognitive behavioural therapy has been shown to change people’s perception of pain, and improve their mood and their ability to cope. CBT can help deal with thoughts and beliefs about pain, overcome problems that the pain is causing, overcome low mood and the sense of loss and frustration, and learn to balance activities and rest to help increase what a person can do without prolonged periods of pain.  

Alternative Therapies And Techniques

Mindfulness

Mindfulness is a technique you learn which involves noticing what’s happening in the present moment, without judgement. It may revolve around being aware of your mind, body or surroundings. Mindfulness has roots in Buddhism and meditation, but you don’t have to be spiritual to practise it. Studies involving people with SCI have shown that practising mindfulness on a regular basis, even for short periods, can have a positive impact on the effects of pain and being better able to manage it.

Acupuncture

Acupuncture works by stimulating blood flow, relaxing muscles, and stimulating the central nervous system which releases chemicals into the muscles, spinal cord and brain to help with pain management. Needles are inserted into the body’s pressure points in order to help the body’s response to pain and improve blood circulation. 

Massages

Combining massage techniques that include deep pressure trigger point therapy, and kneading of specific areas, have been reported to have a positive impact on neuropathic pain. Studies involving massage as a method of neuropathic pain relief are few in number and there is no substantial evidence that massage alleviates pain. 

Exercise

Regular exercise helps increase blood circulation throughout the body which can help reduce neuropathic pain. Focussing on exercise can also distract the mind from concentrating on pain and alleviate symptoms. For people with SCI, undertaking any physical activity should be done following consultation with a medical professional. 

Warm Baths

Whilst it may seem simple, warm water stimulates the body, increasing blood circulation. As a result, pain symptoms may decrease.

Invasive Systems

Spinal cord stimulation, peripheral nerve stimulation, and pain pumps are implantable systems to manage pain. With spinal cord stimulation, thin, insulated wires are inserted into the space surrounding the spinal cord, with peripheral stimulation the wires are inserted under the skin. With both types, a small, implanted generator sends electrical pulses designed to interrupt the signals reaching the brain. Intrathecal pain pumps deliver medication directly to the pain receptors near the spine, interrupting pain signals to the brain, and easing the perception of pain. A small pump is implanted in the abdomen and a pump and catheter are attached. Drawbacks with these kinds of systems usually revolve around problems with the device itself, risk of infection or further neurological damage, although these are rare. 

Organisations That Can Help

• Back Up: the spinal cord injury charity have a useful section on pain management Spinal Cord Injury Pain Management | Back Up (backuptrust.org.uk)
• The British Pain Society: a professional multidisciplinary organisation involved in all aspects of pain and its management The British Pain Society | An alliance of professionals advancing the understanding and management of pain for the benefit of patients
• Pain Concern: a charity working to support and inform people with pain and those who care for them Pain Concern |Pain Concern | Bringing the pain community together
• Pain Support: resources to help in the management of pain Chronic pain support : Painsupport
• Breathworks: Breathworks offer an 8-week course (in person or on-line) developing skills in mindfulness and compassion to live well with chronic pain Mindfulness for Health 8-Week Online Course (breathworks-mindfulness.org.uk)
• Pain Management Network: an Australian website with excellent resources on chronic pain after SCI Introduction to Spinal Cord Injury and Chronic Pain | Pain Management Network (nsw.gov.au)

It's unlikely that anyone experiencing chronic neuropathic pain following spinal cord injury will ever be fully pain-free. However, by consulting with the right specialists and being open to a combination of treatments, those affected can learn ways to manage pain in a way that doesn’t impact on day-to-day life. 

What if My Spinal Cord Injury Wasn’t My Fault?

If your injury was caused as a result of someone else being at fault, you should seek compensation to help pay for the additional support you may require, as well as any lost wages that you would have otherwise earned if not for your injury. Making a successful legal claim will allow you to secure these funds, and it is vitally important that you choose a solicitor with expertise in this area to represent you. The personal injury team at JMW are specialists in supporting clients who have sustained a spinal cord injury that wasn’t their fault, securing millions of pounds in compensation to help them get on with their lives.