Chronic pain and spinal cord injury

With the medical progress that has given spinal cord injured individuals greater longevity and better overall health, chronic pain has emerged as a major challenge in treating this population. Over the past 40 years, estimates of prevalence of severe/disabling chronic pain in spinal cord injury (SCI) patients have ranged from 18% to 63%. Beyond this finding, the extant literature is extremely limited. This review summarizes the empirical findings with regard to the prevalence and clinical significance of chronic pain in the SCI population. In spite of widespread clinical beliefs, there is little evidence that characteristics of the SCI such as the level, completeness, or etiology of the injury are associated with either the development or severity of pain. Until recently, psychosocial issues have been almost totally ignored in spite of the importance such variables have demonstrated in chronic pain in other populations. A major purpose of the present article is to expand the scope of inquiry to include these factors and to emphasize the importance of employing a biopsychosocial model. Evidence is reviewed which suggests that chronic pain is associated with psychosocial impairment in this population. It is concluded that rather than being a minor problem in comparison to the other limitations imposed by SCI, chronic pain represents a significant additional challenge to the SCI patient that may be best addressed by a multidisciplinary approach.