Actionable Nuggets for SCI (3rd ed., 2016)
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.
Chronic musculoskeletal pain requires an interdisciplinary approach, including rehabilitation, and in some cases, surgery.
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.
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 Rehabilitation, 36(9), 705-715. http://doi.org/10.3109/09638288.2013.808708
Additional References (chronological listing):
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Eriks-Hoogland, I. E., Hoekstra, T., de Groot, S., Stucki, G., Post, M. W., & van der Woude, L. H. (2014). Trajectories of musculoskeletal shoulder pain after spinal cord injury: Identification and predictors. The Journal of Spinal Cord Medicine, 37(3), 288–98. http://doi.org/10.1179/2045772313Y.0000000168
Alves, AP; Terrabuio, AA; Pimenta, CJ; Medina, GIS; Rimkus, CM; Cliquet, A. (2012). Clinical Assessment and Magnetic Resonance Imaging of the Shoulder of Patients With Spinal Cord Injury. Acta Ortop Bras, 20(5), 291–296.
Kemp, B.J., Bateham, A.L., Milroy, S.J., Thompson, L., Adkins, R.H., & Kahan, J.S. (2011). Effects of reduction in shoulder pain on quality of life and community activities among people living long-term with SCI paraplegia: A randomized control trial. Journal of Spinal Cord Medicine, 34(3), 278-84.
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Consortium for Spinal Cord Medicine (2005). Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals. Journal of Spinal Cord Medicine, 28(5), 434-70. http://www.pva.org/site/News2?page=NewsArticle&id=7641
Budh, C.N., & Lundeberg, T. (2004). Non-pharmacological pain-relieving therapies in individuals with spinal cord injury: a patient perspective. Complementary Therapies in Medicine, 12(4), 189-197. http://www.sciencedirect.com/science?_ob=ArticleURL…
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Curtis, K.A., et al. (1999). Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users. Spinal Cord, 37(6), 421-9. http://dx.doi.org/10.1038/sj.sc.3100860
Dalyan, M., Cardenas, D.D., & Gerard, B. (1999). Upper extremity pain after spinal cord injury. Spinal Cord, 37(3), 191-5. http://dx.doi.org/10.1038/sj.sc.3100802
Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80(1-2), 1-13. http://dx.doi.org/10.1016/S0304-3959(98)00255-3