Pain After Spinal Cord Injury: An Evidence-based Review for Clinical Practice and Research

J Spinal Cord Med, 2007 · DOI: · Published: January 1, 2007

Spinal Cord Injury Pain Management Research Methodology & Design

Simple Explanation

This article reviews different methods to measure pain after a spinal cord injury (SCI). It looks at how reliable, valid, and practical these methods are. The goal is to suggest specific ways to measure pain in clinical trials. The review focuses on ways to measure pain intensity, how much pain improves, and how pain affects a person's life. It also covers methods to classify pain types, especially neuropathic pain, and ways to test sensitivity to pain. The article suggests using a 0–10 scale to rate pain intensity and a 7-point scale to rate overall improvement. It also recommends specific questionnaires to measure how pain interferes with daily life.

Study Duration

Not specified

Participants

SCI experts

Evidence Level

Review

Key Findings

1
A 0–10 Point Numerical Rating Scale (NRS) is recommended as the outcome measure for pain intensity after SCI.
2
The 7-Point Guy/Farrar Patient Global Impression of Change (PGIC) scale is recommended as the outcome measure for global improvement in pain.
3
The SF-36 single pain interference question and the Multidimensional Pain Inventory (MPI) or Brief Pain Inventory (BPI) pain interference items are recommended as the outcome measures for pain interference after SCI.

Research Summary

This review systematically examines outcome measures for pain after SCI, focusing on reliability, validity, sensitivity, and practicality to recommend specific measures for clinical trials. The review suggests using a 0–10 NRS for pain intensity, the 7-Point PGIC scale for global improvement, and the SF-36 single pain interference question, MPI or BPI pain interference items for pain interference after SCI. The authors also recommend specific tests for mechanical and thermal allodynia/hyperalgesia, and pain taxonomies for classifying pain after SCI.

Practical Implications

Standardized Pain Assessment

Provides clinicians with evidence-based recommendations for selecting appropriate and reliable pain assessment tools for SCI patients.

Improved Clinical Trials

Offers guidance for researchers designing clinical trials related to pain management in SCI, ensuring the use of validated outcome measures.

Enhanced Pain Management

Facilitates better understanding and classification of pain types in SCI, leading to more targeted and effective treatment strategies.

Study Limitations

1
Many measures need further development and determination of reliability and validity in SCI populations.
2
The list of constructs is limited to pain proper and does not include those subjective experiences which are not conceptually related to pain such as quality of life, emotional functioning, and physical functioning.
3
Applicability of some measures without modification for use in evaluating persons with SCI may be questionable especially in regards to the presence of the underlying motor and sensory impairments intrinsic to SCI confounding the outcomes measured.

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