7. Management of Musculoskeletal Pain

Chronic musculoskeletal pain requires an interdisciplinary approach, including rehabilitation, and in some cases, surgery.

The Problem

Musculoskeletal pain is reported by 40-85% of people with spinal cord injuries, most frequently located in the back, neck and upper extremity. Musculoskeletal pain may arise from soft tissue injury, bone or joint injury, nerve root entrapment, overuse syndromes, spasms, or cognitive-affective issues. Common pain syndromes include rotator cuff injury and carpal tunnel syndrome, both related to repetitive over-use of the upper limbs for wheelchair mobility, transfers and self-care. Upper extremity pain has extreme consequences for independence, social participation and quality of life.

Evidence-based Best Practice

Acute and sub-acute musculoskeletal pain should be treated as it would be in the general population. Treatment approaches for musculoskeletal pain with evidence of effectiveness in SCI include: analgesic pharmacotherapy, physiotherapy, massage, exercise and cognitive-behavioral therapy.

For chronic musculoskeletal pain, additional considerations include wheelchair modifications and other assistive devices to relieve pain and prevent further damage. A power wheelchair should be considered for those whose functional mobility in a manual wheelchair is impeded by pain. Interdisciplinary approaches to pain management have been shown to improve function and reduce pain. Corrective surgery may be beneficial, if potential functional gains outweigh losses associated with recovery time.

Key Reference

Michailidou, C., Marston, L., De Souza, L. H., & Sutherland, I. (2014). A systematic review of the prevalence of musculoskeletal pain, back and low back pain in people with spinal cord injury. Disability and Rehabilitation36(9), 705-715. http://doi.org/10.3109/09638288.2013.808708

Actionable Nuggets (4th ed., 2019)

Additional References (since 2016)

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

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