2. The IASP (International Association for the Study of Pain) Classification of Post-SCI Pain is shown below.
A Task Force on Pain Following Spinal Cord Injury of the International Association for the Study of Pain has introduced a taxonomy (Table 1), which classified SCI pain based on presumed etiology.
Table 1. Proposed IASP Classification of Pain Related to SCI
|Nociceptive||Musculoskeletal||-Bone, joint, muscle trauma, or inflammation
-Secondary overuse syndromes
|Visceral||-Renal calculus,bowel, sphincterdysfunction, etc.
|Neuropathic||Above Level||-Compressive mononeuropathies
-Complexregional pain syndromes
|At Level||-Nerve root compression (including cauda equine)
-Spinal cord trauma/ischemia (transitional zone, etc.)
-Dual-level cord and root trauma (double lesion syndrome)
|Below Level||-Spinal cord trauma/ischemia (central dysesthesia syndrome, etc.)|
Tools such as the Leeds assessment of neuropathic symptoms and signs (LANSS) Pain Scale and the DN4 can be helpful in deciding if there is a component of neuropathic pain.
For more information please see: Classification of SCI Pain
2. Musculoskeletal pain is divided into mechanical spine pain and over use pain.
3. This scheme is design to help with the standardization of pain terminology used in the SCI population. Pain is ca tegorized 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.
2. The person identifies the worst pain problem on a body diagram and indicates whether pain worsens with activity, position or change of position or light touch.
3. This procedure is repeated for second worse pain etc. (see Table 2 for categorization).
Table 2. Classification System for Chronic Pain in SCI
|Location||Related to activity||Affected by position||Worse with light touch|
|Neurologic||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||+||+||–|
|Musculoskeletal||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||+||+ / –||–
|Note: + yes, – no, + maybe|
Summary – Classification System for Chronic Pain in SCI
Interpretability – This pain classification provides a nice summary table that makes it easy for clinicians to identify key problem areas that the patient has expressed.
Acceptability – The initial patient burden is high however follow up session will require less time. Interview format improves utility for those with limited hand function.
Feasibility – No special equipment or training is necessary however expertise understanding pain would be an asset. See article for a copy of the tool.
Table 3. Classification System for Chronic Pain in SCI
|++||Inter O ++
Intra O ++
Note: +++ = Excellent; ++ = Adequate; + = Poor; N/A=Insufficient information; Inter O=Interobserver; Intra O=intraobserver
For more information please see: Classification System for Chronic Pain in SCI