Classification System for Chronic Pain in SCI

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Tool Description

  • proposes a pain classification scheme with 2 major categories: neuropathic and musculoskeletal.
  • designed to help with the standardization of pain terminology used in the SCI population.
  • Pain is categorized by pain location and distribution, as related to level of spinal injury (e.g. above level, at level or below level). This information is combined with a classification of the subject’s SCI pain.
  • Neurologic pain – classifications:
    1) SCI pain
    2) Transition zone pain
    3) Radicular pain
    4) Visceral pain
    Musculoskeletal pain – classifications:
    1) Mechanical spine pain
    2) Overuse pain

ICF Domain:

Body Function – Subcategory: Sensory Function.

Number of Items:

2 categories of pain with 6 subcategories. Each subcategory has 3 items to classify pain.

Brief Instructions for Administration & Scoring


  • clinician-administered but could also be completed by the patient.
  • The patient identifies the worst pain problem on a body diagram and indicates whether pain worsens with activity, position or change of position or light touch. This procedure is repeated for second worse pain etc.


Scoring: Categorization is outlined in the table below (fill out with +, - or +)

Pain Category


Pain Category



Related to activity

Affected by position

Worse with light touch


SCI Pain

Below injury in area without normal sensation

Transition zone pain

At level of injury, bilateral

Radicular Pain

At any dermatome level, usually unilateral, usually radiates


In abdomen


Mechanical spine pain

In back or neck, often bilateral

Overuse pain

Often above injury in areas of normal sensation in an incomplete, can be below

+ yes, - no, + maybe


MCID: not applicable
SEM: not applicable
MDC: not applicable

  • This classification system provides a nice summary table that makes it easy for clinicians to identify key problem areas expressed by the patient.



Training Required:

None formally required, but a background in pain knowledge is useful.


See the 'How to use' page.

Clinical Considerations

  • This tool has the most reliable (within (κ=0.68) and between (κ=0.66) raters), standardized system for classifying pain in people with SCI using well defined terminology.
  • The interview format improves utility for those with limited hand function
  • There is a high initial patient burden (considerable time is required to complete the assessment); however, follow up sessions require less time.

Measurement Property Summary

# of studies reporting psychometric properties: 1


  • The strength of agreement between raters in categorizing pain problems was Moderate for both the method of reporting on questionnaire (K=0.68) and reporting in person (K=0.66).

[Cardenas et al. 2002]


  • Results of expert voting to determine Face Validity:
    Valid and useful: 4%
    Useful but requires more validation: 20 % Useful but requires changes/improvement then further validation: 52%
    Not useful or valid for research in SCI: 25%

It was determined to be less valid and useful than both the Bryce-Ragnarsson Pain Taxonomy (BRPT) and the International Association for the Study of Pain (IASP) SCI Classification.

(Bryce et al. 2007; n=59, participants at scientific meeting)


No values have been reported for the responsiveness of the Classification System for Chronic Pain in SCI at this time.

Floor/ceiling effect:

No values were reported for the presence of floor/ceiling effects in the Classification System for Chronic Pain in SCI for the SCI population.


Dr. Janice Eng, Christie Chan, Gita Manhas

Date Last Updated:

July 20, 2020

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Download Worksheet:

Worksheet Document





Equipment Needed

Classification System for Chronic Pain in SCI:

Bryce TN, Budh CN, Cardenas DD, et al. Pain after spinal cord injury: an evidence-based review for clinical practice and research. Report of the National Institute on Disability and Rehabilitation Research Spinal Cord Injury Measures meeting. J Spinal Cord Med. 2007;30(5):421-40.

Cardenas D, Turner J, Warms C, Marshall H. Classification of chronic pain associated with spinal cord injuries. Arch Phys Med Rehabil 2002;83:1708-1714.