Managing SCI pain: A pipe dream?

Contrary to popular belief, people in paralysis can and do experience the agony of pain. Finding suitable ways to manage it remains the only real meaningful solution for now, reports LIANA SHAW

It is a common misconception that someone with SCI would not be able to feel pain owing to loss of sensation. In reality, a type of chronic pain called neurogenic or neuropathic pain often accompanies paralysis, as there is a critical lack of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, in the injured spinal cord.

“This may go so far as to ‘disinhibit’ spiral neurons that are responsible for pain sensations, causing them to fire more than normal,” states the Christopher & Dana Reeve Foundation.

In an article on pain management associated with SCI, published in July, the foundation further cites recent data pointing to a possible shortage of the neurotransmitter norepinephrine coupled with an overabundance of the neurotransmitter glutamate.

Aside from the effects of these chemical changes, people with SCI often experience upper extremity pain from having to push a wheelchair. For those using manual chairs, the experts recommend adjusting the rear axles as far forward as possible and adopting a hand motion that goes around instead of back and forth.

Seat height is important too. It’s advisable to set the axle height so that your fingertips extend just past the axles when you lean back with your arms relaxed. Also ensure that the tyres are inflated correctly at all times – wheelchairs with underinflated tyres are harder to push.

Over time, with age, weight and acute pain setting in, switching from a manual to a power wheelchair could be your best option. There may also come a time when greater reliance on pain medication is needed. Which begs the question: Can pain relief be found in modern medication?

Sadly, it appears current treatment for chronic pain conditions are not only largely ineffective but are mostly used in a trial-by-error manner. The Christopher & Dana Reeve Foundation is calling for the development of new remedies to address this issue. In the meantime, pain sufferers are compelled to look for alternative solutions.

Holistic options

Individuals living with SCI are often encouraged to try non-conventional therapy methods such as heat and massage therapy, acupuncture, exercise, hypnosis, biofeedback, spinal cord stimulation and transcranial electrical stimulation (TCES) techniques. Although not fully accepted in the medical community, many of these therapy methods have proven successful.

Heat and massage therapy have been shown to be effective in managing musculoskeletal pain related to SCI, whereas recent research suggests that acupuncture – a practice that originated in China and dates back 2 500 years – can boost levels of the body’s natural painkillers (endorphins).

Hypnosis is said to help alleviate pain by changing one’s perceptions of discomfort, while biofeedback is heralded as a successful pain treatment by signalling a change in a person’s responses to pain through relaxation techniques. And, of course, good old exercise – the universal recommendation for most ailments – is said to bring about a significant improvement in pain scores in people with SCI.

TCES involves the use of electrodes applied to the scalp, allowing electrical current to stimulate the underlying cerebrum, with studies showing a reduction in pain associated with SCI. In cases of acute and prolonged pain, more drastic measures such as nerve blocks, physical therapy and rehabilitation and even surgery may be recommended.

The pain-relief ladder

When it comes to conventional pain killers, options include a “ladder” of medications, starting with over-the-counter nonsteroidal anti-inflammatories such as aspirin, all the way up to tightly controlled opiates such as morphine.

Aspirins and superaspirins such as celecoxib (Celebrex) coupled with ibuprofen may help with muscle and joint pain but provide no relief from neuropathic pain.

Opioids – ranked at the top of the ladder – include codeine and morphine. The latter is not recommended for long-term use because of its severe side effects such as depressed breathing, constipation and brain fog.

In 2012, the pharmaceutical giant Pfizer received approval from the Food and Drug Administration in the United States for an anticonvulsant called Lyrica to target pain specific to SCI. The company claimed this medication reduces neuropathic pain associated with SCI from baseline compared to placebo.

Notwithstanding, providing chronic pain relief for people with SCI remains a pressing challenge for pharmaceutical companies. Recent data from the national Model Spinal Cord Injury Systems indicate pain prevalence ranging from 81 percent at one year after injury to 82,7 percent at
25 years  – an extremely sad situation indeed.

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