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Classification System of Pain Post SCI

Q21.  Differentiate musculoskeletal pain from central or neuropathic pain from borderzone or segmental pain?
1. Musculoskeletal or mechanical pain occurs at or above the level of the lesion and is due to changes in bone, tendons or joints.
2. Central or neuropathic pain is the most common type of pain experienced below the level of SCI and is generally characterized as a burning, aching and/or tingling sensation.
3. Borderzone or segmental pain is experienced as a band of pain and hyperalgesia at the border zone between diminished or abnormal and preserved sensation.
Musculoskeletal or Mechanical Pain

Musculoskeletal or mechanical pain occurs at or above the level of the lesionand is due to changes in bone, tendons or joints. This is referred to as nociceptive pain caused by a variety of noxious stimuli to normally innervated parts of the body. Overuse of remaining functional muscles after spinal cord injury or those recruited for unaccustomed activity may be of primary importance in some patients.

Central or Neuropathic Dysesthetic Pain

"Central" dysesthesia or "deafferentation" pain is the most common type of pain experienced below the level of SCI and is generally characterized as a burning, aching and/or tingling sensation. In many cases this dysesthetic or deafferentation pain has defied a pathophysiological explanation. Excluding radicular pain, all other pains of paraplegia are central or deafferentation in origin. This pain is most often perceived in a generalized manner below the level of the lesion, often as a diffuse burning type of pain. Burning pain is reportedly most common with lesions at the lumbar levels.

One study refers to this pain as Central Dysesthetic Pain (CDP) and found dissociative sensory loss and absence of spinothalamic-anterolateral functions, with varying degrees of dorsal column function preservation present almost exclusively in incomplete SCI patients. CDP takes weeks or months to appear and is often associated with recovery of some spinal cord function. Paradoxically CDP is often characterized by complete loss of temperature, pinprick, and pain perception below the level of the lesion. It rarely occurs in spinal cord Injuries with complete sensory loss or loss of both sensory and motor functions below the level of the lesion.

Borderzone or Segmental Pain

Individuals with SCI frequently experience a band of pain and hyperalgesia at the border zone between diminished or abnormal and preserved sensation. In the more recent literature, this segmental pain is further described as occurring at or just above the level of sensory loss in the cutaneous transition zone from the area of impaired/lost sensation to areas of normal sensation, involving at least one to three dermatomes and is often associated with spontaneous painful tingling or burning sensations in the same area.  Pain can be triggered by stroking and/or touching the skin in adjacent painful dermatomes. Segmental pain is generally symmetrical although a partial spinal cord injury with asymmetrical neurological involvement will produce asymmetries. This pain has also been described as "neuropathic at level pain."

For more information please see: Classification System of Pain