5. Assessment of Pain in SCI Patients

Actionable Nuggets for SCI (3rd ed., 2016)

Distinguish between neuropathic and musculoskeletal pain in your patient with SCI, and monitor pain regularly.

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, even at the same location. SCI pain can be broadly classified as either neuropathic or musculoskeletal. Often both types of pain co-exist in this population. Implications for management differ significantly depending on the origin of pain.

Evidence-based Best Practice:

People with SCI live with many questions regarding their pain, and with a sense that no one adequately understands their pain, including their family physician. 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 or characteristics, timing, and interference with function.

The DN4 (Douleur Neuropathique en 4 Questions) is a screening tool that has been shown to distinguish well between neuropathic and musculoskeletal pain, and to have superior validity, sensitivity and specificity. Using the cut-off score of 4/10, the DN4 shows 83% sensitivity and 90% specificity (see attached).

DN4 – Questionnaire

Key Reference:

Saulino, M. (2014). Spinal Cord Injury Pain. Physical Medicine and Rehabilitation Clinics of North America, 25(2), 384–391. http://doi.org/10.1016/j.pmr.2014.01.002

Additional References (chronological listing):

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