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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).

Table 1 International Spinal Cord Injury Pain Classification (Bryce et al. 2012)

Tier 1: Pain typeTier 2: Pain subtypeTier 3: Primary pain source and/or pathology
NociceptiveMusculoskeletale.g. glenohumeral arthritis, lateral epicondylitis, comminuted femur fracture, quadratus lumborum muscle spasm.
Viscerale.g. myocardial infarction, abdominal pain due to bowel impaction, cholecystitis.
Other nociceptive paine.g. autonomic dysreflexia headache, migraine headache, surgical skin incision.
NeuropathicAt Level SCI paine.g. spinal cord compression, nerve root compression, cauda equine compression
Below level paine.g. spinal cord ischemia, spinal cord compression
Other neuropathic paine.g. carpal tunnel syndrome, trigeminal neuralgia, diabetic polyneuropathy.
Other paine.g. fibromyalgia, Complex Regional Pain Syndrome type I, interstitial cystitis, irritable bowel syndrome
Unknown pain

Table 2 Previous IASP Classification of Pain Related to SCI (Burchiel & Hsu 2001)

Broad Type

(Tier 1)

Broad System

(Tier 2)

Specific Structure/Pathology

(Tier 3)

NociceptiveMusculoskeletalBone, joint, muscle trauma, or inflammation

Mechanical instability

Muscle spasm

Secondary overuse syndromes

VisceralRenal calculus, bowel, sphincter dysfunction, etc.

Dysreflexic headache

NeuropathicAbove LevelCompressive mononeuropathies

Complex regional pain syndromes

At LevelNerve root compression (including cauda equine)

Syringomyelia

Spinal cord trauma/ischemia (transitional zone, etc.)

Dual-level cord and root trauma (double lesion syndrome)

Below LevelSpinal cord trauma/ischemia (central dysesthesia syndrome, etc.)

Table 3 SCI pain types according to major classification

Table 3 SCI pain types according to major classification*

Bryce/RagnarssonCardenasDonovanISAPTunks
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)

*This article was published in Physical Medicine and Rehabilitation Clinics of North America, 18, Ullrich, Pain Following Spinal Cord Injury, 217-233, Copyright Elsevier (2007).

Table 4 Reliability of SCI pain classification systems

Kappa coefficient1Percent agreement
Bryce and colleagues.70Unavailable
Cardenas.68Unavailable
Donovan.5550%-62%
IASP.4952%
Tunks.4927%

1Kappa coefficient is the proportion of agreement controlling for change agreement, with 1.0 representing perfect agreement between raters. Kappa coefficients greater than .60 or .70 reflect substantial interrater agreement.

This article was published in Physical Medicine and Rehabilitation Clinics of North America, 18, Ullrich, Pain Following Spinal Cord Injury, 217-233, Copyright Elsevier (2007).