Pain Treatment in Spinal Cord Injury: The Role of Non-pharmacological and Topical Treatments

Pain is one of the most prevalent and debilitating secondary conditions in people living with spinal cord injury. More than half of the people living with spinal cord injury experience pain at some point during their lives. Regular medication for pain is often insufficient and prone to side-effects. This thesis gives an overview of pain treatments in spinal cord injury besides regular medication. It consists of three parts.
The first part describes the prevalence and determinants of SCI-related pain during inpatient rehabilitation. Presence of pain at admission and discharge from eight rehabilitation centers in the Netherlands are reported. Prevalence was reported as 61.2% experiencing pain at admission and 51.5% at discharge. Several determinants were found to be related to having pain. Traumatic SCI and female sex were associated with nociceptive pain while people suffering from AIS B and C were less likely to have nociceptive pain. Female sex, people with tetraplegia and an age younger than 65 years compared to older than 75 years were associated with having neuropathic pain. During inpatient rehabilitation there was a decrease in prescribed oral medication for nociceptive pain, while there was an increase in prescribed oral medication for neuropathic pain.
The second part describes the use of non-pharmacological treatments. Many different types of these non-pharmacological treatments are tried by people with spinal cord injury. These treatments can be physical, psychological or based on complementary and alternative medicine. People described the use of different types of these treatments to find pain reduction. Effectiveness of these treatments differ greatly between people with spinal cord injury. Most evidence in our thesis and the scientific literature can be found for physical treatments. The journey to finding these treatments is described as frustrating and lonely. People seek support and guidance from health care professionals, which they often do not find.
The third part describes the use of topical analgesics for neuropathic pain in people with spinal cord injury. New emerging strategies using pain reducing creams have emerged in the past couple of decades. In clinical practice, they are already used for people with spinal cord injury. These treatments have fewer side-effects and the first results we present show that reduction of pain can be accomplished by these treatments.
This thesis shows that pain treatment in spinal cord injury should be multidimensional at an early stage, using different types of treatment strategies. Health care professionals should accompany people with spinal cord injury at an early stage in finding possible treatments. If a small part of the body is affected by neuropathic pain, topical analgesics can be considered in addition to oral pharmacological pain treatment.