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Spinal Cord Injury ll: Pathophysiology

Spinal Cord Injury ll: Pathophysiology

Spinal cord injury progresses through two interconnected phases: primary injury and secondary injury.Primary InjuryPrimary injury happens at the moment of trauma and involves immediate mechanical damage to the spinal cord.Compression happens when broken vertebrae, herniated discs, or accumulating blood (such as a hematoma) press directly against the spinal cord, distorting its normal shape and function. In cases of contusion, the cord is bruised by a blunt force (like penetrating injuries or...

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Spinal Cord Stimulation for Pain Management Following Spinal Cord Injury: A Systematic Review.

David M Gallacher¹, Michael Suarez², David S Jevotovsky³

¹Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.

Journal of Pain Research

|April 6, 2026

Summary

Spinal cord stimulation (SCS) shows promise for chronic pain after spinal cord injury (SCI), with few reported complications. However, very low-certainty evidence necessitates further high-quality research to confirm benefits and risks.

Keywords:

chronic pain pain management spinal cord injury spinal cord stimulation

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Area of Science:

Neurology
Pain Management
Rehabilitation Medicine

Background:

Chronic pain is prevalent in over 80% of spinal cord injury (SCI) patients, significantly impacting function and quality of life.
Existing treatments for SCI-related neuropathic pain are often inadequate.
Spinal cord stimulation (SCS) is an emerging neuromodulatory therapy with potential for neuropathic pain management.

Purpose of the Study:

To systematically review the current evidence on the efficacy and safety of spinal cord stimulation (SCS) for chronic pain in adults with spinal cord injury (SCI).
To assess the quality of evidence and identify gaps in the literature regarding SCS for SCI pain.

Main Methods:

A systematic review adhering to PRISMA 2020 guidelines was conducted.
Searches were performed across major databases (PubMed, Embase, Web of Science, Cochrane Library) through April 2024.
Included studies evaluated SCS for chronic pain in adults with SCI, assessing pain or patient-reported outcomes; risk of bias and certainty of evidence were evaluated using GRADE and MASTER tools.

Main Results:

Ten studies with 43 participants met the inclusion criteria; most were case reports or small series.
All studies indicated pain improvement with SCS, though outcome reporting was heterogeneous.
Minor adverse events were reported in 3 studies; the remaining 7 reported none. Certainty of evidence was rated as very low.

Conclusions:

Preliminary evidence suggests SCS may be a promising option for managing chronic pain post-SCI, with a seemingly low complication rate in current literature.
The very low certainty of evidence underscores the need for high-quality studies to validate efficacy, define risks, and optimize SCS application in SCI patients.