Spinal cord injury and chronic pain

### Key points Pain is defined by the International Association for the Study of Pain (IASP) as ‘an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. Pain is classified as acute if it is 12 weeks and persists despite an apparent lack of ongoing injury. In spinal cord injury (SCI) patients, chronic pain is common. It impacts about 70% of patients with one-third of these experiencing severely intense pain impacting on mood, functioning, and quality of life.1 The pain can be nociceptive, neuropathic, or visceral. Nociceptive is the most common and can be due to the initial trauma, muscle and joint overuse, for example, upper limbs and wheelchair use, and injury-related muscle weakness, spasm, and contractures. Neuropathic pain can develop acutely or after 1 yr post-injury and can present at or below the level of injury. Visceral pain is thought to originate from the abdomen or thorax and may be related mainly to constipation. We review here the classification, mechanisms, clinical diagnosis, and management of pain in SCI patients. ### Classification of the neurological deficits in SCI patients The American Spinal Injury Association (ASIA) classifies SCI on the degree of sensory and motor loss. The level of injury is defined as the lowest spinal segment with intact sensation and antigravity muscle strength (MRC power >3) where there is …