The problem of pain and its management

Chronic pain is a substantial and serious problem that many people with spinal cord injury (SCI) live with, and it has the potential to significantly impair their function and quality of life. Approximately 65% of people are affected by pain after SCI, with around one third of these experiencing severe pain. The most common classification scheme used for this group of pain disorders divides them into two broad types: nociceptive and neuropathic pain. While the mechanisms underlying the former are reasonably well understood and thought to be similar to those observed in other pain populations, neuropathic pain conditions are less well explained. Biopsychosocial models of pain in SCI are receiving increasing attention. Biological changes in spinal cord and brain anatomy, neurochemical and excitotoxic changes, inflammatory changes and sympathetic involvement are all thought to play a role in the development of pain. Important psychological factors include cognitions and affect. Social factors are perhaps least explored but their significance is increasingly being highlighted. Pain in SCI, particularly neuropathic pain, is often refractory to current treatments, such as medication and surgery. Recent exploration of the application of cognitive behavioural pain management programmes, and novel applications of treatments for other neuropathic pain conditions, such as complex regional pain syndrome, offer hope for the future both in ameliorating the effects of pain on quality of life and ultimately pain relief.