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Pain Management

Classification of SCI Pain

Siddall et al. (1997) noted that one of the concerns regarding SCI-related pain was a lack of consensus over a classification system for SCI pain. This has led to considerable variation in incidence and prevalence rates for pain post SCI depending on the classification system used. Twenty-eight classification schemes have been published between 1947 and 2000. A Task Force on Pain Following Spinal Cord Injury of the International Association for the Study of Pain has introduced a taxonomy, which classified SCI pain based on presumed etiology (Burchiel & Hsu 2001; Siddall et al. 2000). Recently, an international group of clinicians and researchers developed a consensus for an SCI pain classification, International Spinal Cord Injury Pain Classification (ISCIP Classification). The overall structure of the ISCIP classification is similar to that developed by the previous IASP classification of pain related to SCI. However, the new system has merged and improved on previously published SCI classification systems. The ISCIP classification incorporates common pain pathology after SCI even those not necessarily related to SCI itself (Bryce et al. 2012).

Tier 1: Pain type Tier 2: Pain subtype Tier 3: Primary pain source and/or pathology
Nociceptive Musculoskeletal e.g. glenohumeral arthritis, lateral epicondylitis, comminuted femur fracture, quadratus lumborum muscle spasm.
Visceral e.g. myocardial infarction, abdominal pain due to bowel impaction, cholecystitis.
Other nociceptive pain e.g. autonomic dysreflexia headache, migraine headache, surgical skin incision.
Neuropathic At Level SCI pain e.g. spinal cord compression, nerve root compression, cauda equine compression
Below level pain e.g. spinal cord ischemia, spinal cord compression
Other neuropathic pain e.g. carpal tunnel syndrome, trigeminal neuralgia, diabetic polyneuropathy.
Other pain e.g. fibromyalgia, Complex Regional Pain Syndrome type I, interstitial cystitis, irritable bowel syndrome
Unknown pain
Broad Type(Tier 1) Broad System(Tier 2) Specific Structure/Pathology(Tier 3)
Nociceptive Musculoskeletal Bone, joint, muscle trauma, or inflammation

Mechanical instability

Muscle spasm

Secondary overuse syndromes

Visceral Renal calculus, bowel, sphincter dysfunction, etc.

Dysreflexic headache

Neuropathic Above Level Compressive mononeuropathies

Complex regional 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.)
Bryce/Ragnarsson Cardenas Donovan ISAP Tunks
Above level

1)     Nociceptive

2)     Neuropathic

At level

3)     Nociceptive

4)     Neuropathic

Below level

5)     Nociceptive

6)     Neuropathic


1)     Spinal cord

2)     Transition zone

3)     Radicular

4)     Visceral


5)     Mechanical spine

6)     Overuse

1)     Segmental

2)     Spinal cord

3)     Visceral

4)     Mechanical

5)     Psychogenic


1)     Musculoskeletal

2)      Visceral


3)     Above level

4)     At level

5)     Below level

Above level

1)    Myofascial

2)    Syringomyelia

3)    Non-spinal cord injury

At level

4)    Radicular

5)    Hyperalgesic border reaction

6)    Fracture

7)    Myofascial (incomplete)

Below level

8)    Diffuse burning

9)    Phathom

10)  Visceral

11)  Myofascial (incomplete)

Kappa Coefficient Percent Agreement
Bryce and colleagues 70 Unavailable
Cardenas 68 Unavailable
Donovan 55 50%-62%
IASP 49 52%
Tunks 49 27%
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