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 in throughout body where there is normal sensation (feeling) as well as 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 – which despite the recent advances in basic science and clinical research, the mechanisms and treatment of chronic pain following spinal cord injury remains largely unknown
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 referred to as “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 that 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 to occur gradually after the initial injury and may become worse over time as the body adjusts to its condition – or in certain conditions as noted below, pain can occur years later if a spinal cord becomes filled with fluid.
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 is can be present where you have no sensation. Central Pain Syndrome can be felt as a burning pain, a “pins and needles” type 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. It can get worse over time. It can be felt as a stabbing pain or 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 that 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 where a person still has normal sensation. 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) causes this type of 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 the use of these muscles. For example, individuals may experience musculoskeletal pain in their arms from pushing their wheelchair or leaning on the elbows more than before the injury.
Pain in the upper extremities is often caused by overuse of the muscles. Overuse can be triggered by transfer movement, pressure relief maneuvers and from manually pushing a wheelchair. 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 ect.) 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. Muscoloskeletal pain normally gets worse with movement and better with rest.
Visceral Pain – another type of chronic pain that is commonly experienced by spinal cord injury victims 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 that 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 (that were damaged by in 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.
Studies have shown other Factors that worsen spinal cord injury pain, such as:
Generally, since the pain can range in consistency and more research is necessary on its origins and causes, there are minimal treatment options available for those who are injured.
We would suggest always maintaining contact with your doctor or specialist, who may probably try a combination of treatment, such as medicine (drugs) physical and psychological therapy for pain management.
Your rehabilitation therapist may suggest activity modification for your mechanical or musculoskeletal pain. You can also look into changing up your ambulation/mobility equipment, modifying your wheelchair movement and transfer techniques in order 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 are triggering 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 oxucodone, 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, it’s important that you never use alcohol or illicit drugs to help ease your pain. The combination of medicine you may be taking and alcohol can be a very deadly combination.
If you have serious chronic pain as a result of a spinal cord injury, it’s very important that you get treatment sooner rather than later. Speak to you doctor, physiatrist, occupational therapist or rehab worker to help locate ideal sources of treatment 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 that you are properly assisted financially. We never charge to talk about a case and if we decide to work together, we will never ask you for money upfront. If you are incapable of traveling to us, we will come to you and meet you where you feel comfortable.
Contact our offices at 905-333-8888 or fill out a contact form on our website to request your consultation today.
*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)