Pain is no doubt a serious problem for many, if not most, spinal cord injury victims. It is well known that pain after SCI can occur throughout the body where there is normal sensation (feeling) and areas where you have little to no sensation. Chronic pain can have a terribly negative impact on a person’s quality of life. Most spinal cord injury victims often endure agonizing and unyielding chronic pain that is largely defiant to treatment. Despite the recent advances in basic science and clinical research, the mechanisms and treatment of chronic pain following spinal cord injury remain largely unknown.
Why does chronic pain occur with a spinal cord injury?
From what has been explained to us. Generally, chronic pain after a spinal cord injury happens because the body has suffered significant damage to the central nervous system. In the medical world, this is called “central pain” because of its direct connection to the nerves and the body’s function. A leading scientific theory is that central pain occurs because of issues in the thalamus, the part of the brain that connects the nervous system to the cerebral cortex.
The thalamus has a significant role in cognitive function, as it is a primary method of communication between the nervous system. As a result, when the thalamus experiences abnormal interruptions or suppression of its normal functions, such as an interruption via spinal cord injury, pain signals and receptors are inhibited, and signals in the pain system are blended. In other words, when the thalamus cannot do its job because of paralysis and nerve injury, pain signals become confused and sent elsewhere.
Regardless of the cause, this type of pain can be excruciating for a person who has suffered a spinal cord injury. It can be relentless, and there are minimal options available that can actually assist in decreasing the pain. As a result, the individual’s quality of life may become very severely impacted – to the point where it can hinder an individual’s ability to perform daily tasks.
Sometimes, this pain begins gradually after the initial injury and may worsen over time as the body adjusts to its condition. In certain conditions, as noted below, pain can occur years later if a spinal cord becomes filled with fluid.
Types of Chronic Pain from a Spinal Cord Injury
Chronic pain resulting from spinal cord injury can manifest in a variety of ways, each with its own classifications and risk factors.
Central pain: Central pain is the most problematic type of pain experienced by spinal cord injury survivors. Central pain interferes with the quality of a person’s life. It may be a constant pain or a periodic pain. One oddity about central pain is that it can be present where you have no sensation. Central Pain Syndrome can be felt as a burning pain, a “pins and needles” type of pain, or a feeling like a “numbness” at or below the level of injury. This type of pain starts weeks or months after a spinal cord injury. Central pain has also been described as throbbing or tingling and as “the pain beyond pain.”
Root Pain: Root pain is felt at or below the level of injury. It can start days or weeks after the initial injury and worsen over time. It can be felt as a stabbing pain, a sharp pain, or a band of burning pain where normal feeling stops. Light touch can worsen this pain.
Syrinx pain: Syrinx pain is quite rare. A syrinx is a hollow, fluid-filled cyst or cavity that sometimes forms in the spinal cord as it heals. The cyst can enlarge over time, causing pain and loss of feeling – once the cyst develops, the actual condition is called Syringomyelia. Over time, the cyst can enlarge and cause damage to the spinal cord and cause pain, weakness and stiffness, among other symptoms. A person will feel pain. It’s very important that if you feel new pain in your spine in the year or more after injury, you contact a doctor, especially if you notice any new loss of sensation in areas around the level of your injury and your muscle weakness that doesn’t improve with rest.
Mechanical and Musculoskeletal Pain: Mechanical pain happens when a person still has normal sensations. It can be a sudden sharpness. It can be a dull ache. A lot of physical activity can make mechanical pain worse. Muscle overuse, muscle damage, unstable bone fractures, infection, or deforming changes in bones (osteoporosis) and joints (arthritis) cause this pain. Paraplegics who use manual wheelchairs commonly experience mechanical pain.
Wheelchair propulsion and transfers from one place to another are the most common ways paraplegics become injured. Musculoskeletal pain often occurs in areas that become overused as a result of loss of function in the lower body, such as the arms and shoulders. When an individual becomes confined to a wheelchair or cannot use the function of their legs and thighs, they rely twice as much on using these muscles. For example, individuals may experience musculoskeletal pain in their arms from pushing their wheelchair or leaning on their elbows more than before the injury.
Pain in the upper extremities is often caused by overuse of the muscles. Transfer movement, pressure relief maneuvers, and manual pushing of a wheelchair can trigger overuse. Spinal cord Injury victims who suffer higher-level injuries and use computers or joysticks for many daily actions (such as movement, reading, communicating, environmental controls, etc.) may no doubt develop pain in the hand, arm or shoulder from repetitive movements. Upper limb pain can also make it difficult for a person to transfer safely and perform activities of daily living. Musculoskeletal pain normally gets worse with movement and better with rest.
Visceral Pain: another type of chronic pain that spinal cord injury victims commonly experience is visceral pain that may develop in the abdomen. Usually, this may cause cramping or aching. This occurs because of the loss of function in bladder control and digestive function, which results in lowered digestive function and susceptibility to conditions such as kidney stones and appendicitis. Both musculoskeletal pain and visceral abdominal pain may be treated with physical therapy, anti-inflammatory medications, or prescription opioids if the pain becomes severe. Exercise may also be an option for pain regulation.
Neuropathic Pain: spinal cord injury victims may also experience neuropathic pain. Neuropathic pain is thought to be when your brain “misinterprets” or amplifies the intensity of the signals you are getting from around the area in your body below your injury where you experience little to no feeling. Neuropathic pain is normally caused by abnormal communication between the nerves (damaged by your spinal cord injury) and the brain, where nerve signals that inform your brain how your body feels are interpreted.
To date, there are little to no options to assist in managing this type of pain as there is still a significant amount of research required as to how this type of pain occurs.
Other issues that factor into spinal cord injury-related chronic pain:
Studies have shown other Factors that worsen spinal cord injury pain, such as:
- Urinary Tract Infections (UTIs)
- Viral Illnesses (cold, flu, etc.)
- Changes in your sleep cycle
- Changes in your daily activity
- Menstrual cycle
- Upset stomach caused by heartburn or constipation)
- Prolonged sitting
- Fatigue
- Muscle spasms
- Cold weather and
- Sudden movements.
Are there any treatment options available?
Generally, since the pain can range in consistency and more research is necessary on its origins and causes, minimal treatment options are available for those injured.
We suggest always maintaining contact with your doctor or specialist, who may try a combination of treatments, such as medicine (drugs) and physical and psychological therapy for pain management.
Your rehabilitation therapist may suggest activity modification for your mechanical or musculoskeletal pain. You can also consider changing your ambulation/mobility equipment, modifying your wheelchair movement, and using transfer techniques to lessen the pressure on your upper extremities.
You may also want to look into physical therapy and exercises that strengthen your painful joints, increase your stretching routine, get some massage therapy to relieve muscle tightness, and purchase a TENS machine to help block signals from areas that trigger a pain response.
We always suggest that psychological help can certainly assist with pain management. A pain psychologist can assist in teaching you proper relaxation techniques, hypnosis and how to think differently about your pain and how to deal with it.
Medication is often used to relieve both neuropathic and mechanical pain. We have seen narcotics such as oxycodone, hydrocodone and, of course, morphine used to help manage a spinal cord injury victim’s pain symptoms – mostly for neurogenic and mechanical pain. You may also want to ask your doctor about muscle relaxants, anti-spasticity drugs and topical anesthetics.
With this in mind, you must never use alcohol or illicit drugs to help ease your pain. The combination of medicine you may be taking, and alcohol can be very deadly.
Was your SCI caused by someone who was negligent? Our Hamilton spinal cord injury lawyers have been helping injured victims since 2003, and we can help secure funding for the treatment of your chronic pain.
If you have serious chronic pain as a result of a spinal cord injury, you must get treatment sooner rather than later. Speak to your doctor, physiatrist, occupational therapist or rehab worker to help locate ideal treatment sources for you. You may also benefit from a multi-disciplinary pain clinic. Remember – suffering from pain is not a hopeless situation. Be open to trying a variety of treatment techniques. If you have any questions regarding the financial assistance required for pain treatment and your spinal cord injury was caused by someone’s negligence, you have recourse for compensation for your care.
Our Hamilton spinal cord injury lawyers are more than just legal advisors. Our team can provide you with valuable resources and assistance to ensure you are properly financially assisted. We never charge to discuss a case, and if we decide to work together, we will never ask you for money upfront. If you cannot travel to us, we will come to you and meet you where you feel comfortable.
At Lalande Personal Injury Lawyers, we take pride in being trusted Hamilton personal injury lawyers since 2003. Over the years, we’ve helped our clients recover more than $45 Million in settlements and verdicts in personal injury, disability, and employment law cases. Whether you’re dealing with a life-changing injury, a denied disability claim, wrongful death, a hurt child or employment termination, we are here to provide compassionate and experienced legal representation. If you believe you have a case, call us today—we’re ready to help you secure the compensation you deserve.
Call Lalande Personal Injury Lawyers today, no matter where you are in Ontario at 905-333-8888 for your free consultation. Alternatively, you can contact us online, confidentially, by filling out a contact form.
*This information has been obtained from our experience and knowledge of spinal cord injury law as well as Medical Peer Reviewed Journals and Medical Studies from SCIRE (Spinal Cord Injury Research Evidence)