Identifies 11 types of pain for those with spinal cord injury according to the lesion level.

Above the lesion level At the lesion level Below the lesion level
1. Myofacial
2. Syringomyelia
3. Non spinal cord
4. Radicular
5. Hyperalgesic border reaction
6. Fracture
7. Myofacial (incomplete lesion)
8. Diffuse burning
9. Phantom
10. Visceral
11. Myofacial (incomplete lesion)

Clinical Considerations

  • The classification system does not follow a systematic method for acquiring the data from the patients, thus obtaining consistent information from one time to another or between individuals very difficult.
  • This system is very clinician dependent as it requires considerable knowledge about the various origins of pain to be able to interpret the patient’s comments into the defined classification scheme.
  • Although this system has merit for giving more categories for which to describe the various types of pain an individual may have, it most likely would be useful for more complex pain cases where more time is allocated towards understanding the origins of the individual’s pain.

ICF Domain

Body Function ▶ Sensory Functions


  • Clinician-administered; information is obtained through a semi-structured interview.
  • This pain classification allows the clinician to describe the general location and whether the pain differentiates between several types of pain.
  • Administration time is usually 15-20 minutes, but it may take longer for more complex cases.

Number of Items






Training Required

  • No formal training required. However, knowledge of neuro-anatomy and physiology – specifically sensation and theories of pain is beneficial.
  • This system requires considerable knowledge from the clinician classifying the pain as well as from other health care professionals who may be using the information to help with pain management.


Can be found in the appendix of the following article:

# of studies reporting psychometric properties: 1


MCID: not established in SCI
SEM: not established in SCI
MDC: not established in SCI


Low to Moderate Inter-rater reliability between 3 raters:
Kappa coefficient = 0.33 – 0.65
Rate of agreement across all raters was 17%.

(Putzke et al. 2003)


No values were reported for the validity of Tunk’s Classification Scheme for the SCI population.


No values were reported for the responsiveness of Tunk’s Classification Scheme for the SCI population.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the Tunk’s Classification Scheme for the SCI population.


Nicole Elfring, Matthew Querée, Joanne Chi

Date Last Updated

15 July 2019

Putzke JD, Richards JS, Ness T, Kezar L. Interrater reliability of the International Association for the Study of Pain and Tunks’ spinal cord injury pain classification schemes. Am J Phys Med Rehabil 2003;82:437-440.

Tunks E. Pain in spinal cord injured patients. In: Bloch R, Basbaum M (ed). Management of Spinal Cord Injuries. Williams and Wilkins, Baltimore, MD, 1986: p 180-211.