• Proposes a pain classification system 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

Clinical Considerations

  • This tool is a reliable (within (κ=0.68) and between (κ=0.66) raters) and 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.

ICF Domain

Body Function ▶ Sensory Function

Administration

  • 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.

Number of Items

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

Equipment

None

Scoring

Categorization is outlined in the table below (fill out with +, – or +).

Pain Category (major)

Pain Category (Specific)

Location

Related to activity

Affected by position

Worse with light touch

Neuropathic

 SCI pain

Below injury in area without normal sensation
Neuropathic

Transition zone pain

At level of injury, bilateral
Neuropathic

Radicular Pain

At any dermatome level, usually unilateral, usually radiates
Visceral

In abdomen

Musculoskeletal

Mechanical spine pain

In back or neck, often bilateral

Musculoskeletal

Overuse pain

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

+ yes, – no, + maybe

Languages

English

Training Required

No formal training required. However, knowledge of pain is beneficial.

Availability

The Classification System for Chronic Pain in SCI worksheet can be found here.

# of studies reporting psychometric properties: 2

Interpretability

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

MCID: not established in SCI
MDC: not established in SCI
SRD: not established in SCI

Reliability – Moderate

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)

Validity

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)

Responsiveness

No values have been reported for the responsiveness of the Classification System for Chronic Pain for the SCI population.

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.

Reviewers

Dr. Carlos L. Cano-Herrera, Elsa Sun

Date Last Updated

31 December 2024

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.
http://www.ncbi.nlm.nih.gov/pubmed/18092558

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.
http://www.ncbi.nlm.nih.gov/pubmed/12474174

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