5. Assessment of Pain in SCI Patients

Screen for pain at every encounter, and distinguish between neuropathic and musculoskeletal or other non-neuropathic pain.

The Problem

Between 48 and 94% of individuals with spinal cord injury (SCI) experience chronic pain. SCI-related pain is challenging to diagnose, because as many as eight different types of pain may occur alone or in combination. SCI pain can be broadly classified as either neuropathic or musculoskeletal. Implications for management differ significantly depending on the origin of pain

Evidence-based Best Practice

The most commonly used measure of pain — the 10-point visual analogue scale (VAS) — is inadequate to capture the complexity of SCI pain. In order to obtain a comprehensive evaluation of SCI pain, the following dimensions should be evaluated: Site, Frequency, Intensity, Duration, Pain quality/characteristics, Timing, and Interference with function.

A 4-item screening tool is recommended for distinguishing neuropathic from non-neuropathic pain: The Spinal Cord Injury Pain Instrument (SCIPI). At a cut-off score of 2/4 (50%), the SCIPI has sensitivity of 78%, specificity of 73% and diagnostic accuracy of 76%.

Key Reference

Bryce, T., Richards, J., & Bombardier, C. (2014). Screening for neuropathic pain after spinal cord injury with the Spinal Cord Injury Pain Instrument (SCIPI): a preliminary validation study. Spinal Cord, 52(5), 407–12. http://doi.org/10.1038/sc.2014.21

Actionable Nuggets (4th ed., 2019)

Additional References (since 2016)

Franz, S., Schuld, C., Wilder‐Smith, E. P., Heutehaus, L., Lang, S., Gantz, S., . . . Weidner, N. (2017). Spinal cord injury pain instrument and painDETECT questionnaire: Convergent construct validity in individuals with spinal cord injury.European Journal of Pain, 21(10), 1642-1656. doi:10.1002/ejp.1069

Müller, R., Brinkhof, M. W. G., Arnet, U., Hinrichs, T., Landmann, G., Jordan, X., . . . for the SwiSCI Study Group. (2017). Prevalence and associated factors of pain in the swiss spinal cord injury population.Spinal Cord, 55(4), 346-354. doi:10.1038/sc.2016.157

Mahnig, S., Landmann, G., Stockinger, L., & Opsommer, E. (2016). Pain assessment according to the international spinal cord injury pain classification in patients with spinal cord injury referred to a multidisciplinary pain center.Spinal Cord, 54(10), 809-815. doi:10.1038/sc.2015.219

Widerström-Noga, E., Felix, E. R., Adcock, J. P., Escalona, M., & Tibbett, J. (2016). Multidimensional neuropathic pain phenotypes after spinal cord injury.Journal of Neurotrauma, 33(5), 482-492. doi:10.1089/neu.2015.4040

Barbetta, D. C., Lopes, A. C. G., Chagas, F N M R, Soares, P. T., Casaro, F. M., Poletto, M. F., . . . Ogashawara, T. O. (2016). Predictors of musculoskeletal pain in the upper extremities of individuals with spinal cord injury.Spinal Cord, 54(2), 145-149. doi:10.1038/sc.2015.126