ABSTRACT
Pain following spinal cord injury (SCI) is common and often severe, even in the acute phase. Neuropathic pain can occur above the neurological level of injury and includes pains that are not specific to SCI, such as complex regional pain syndrome and pain due to peripheral nerve injury. Below-level neuropathic pain may also be dependent on the presence of a spinal generator. A higher proportion of patients with below-level neuropathic SCI pain have sensory hypersensitivity in dermatomes at the neurological level of injury than pain-free SCI patients. The presence of visceral pain requires a standard diagnostic approach similar to that used in the person without SCI. Muscle spasm is also a common problem following SCI, associated with tissue trauma and altered inhibitory control. Antidepressants, and in particular tricyclic antidepressants, are widely used in the management of neuropathic pain conditions, although there is little direct evidence for effectiveness in neuropathic SCI pain.
