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)
Syringomyelia 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 |
Neurologic
1) Spinal cord 2) Transition zone 3) Radicular 4) Visceral Musculoskeletal 5) Mechanical spine 6) Overuse |
1) Segmental
2) Spinal cord 3) Visceral 4) Mechanical 5) Psychogenic |
Nociceptive
1) Musculoskeletal 2) Visceral Neuropathic 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% |
