- Focus on Secondary Condition Prevention: Promoting Enabling and Empowering Fitness Environments to Increase Exercise and Improve Health for People with Multiple Sclerosis
- Spinal Cord Injury
- Amputation and Secondary Conditions: Physical Activity Can Reduce Secondary Conditions in Youths With Limb Differences
- Primer on Pain
- Metabolic and cardiopulmonary responses to acute progressive resistive exercise in a person with C4 spinal cord injury.
- Effect of a Holistic Health Promotion Program on Individuals with Spinal Cord Injury
- Focus on Secondary Condition Prevention: NCHPAD Resources for Pain Management
- Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being.
- Exercise a Pain in the.... Head?
- Blood pressure and heart rate response to isometric exercise: The effect of spinal cord injury in humans.
- Focus on Secondary Condition Prevention: Non-Traditional Exercise as a Way of Preventing Secondary Conditions - Part II
- Focus on Secondary Condition Prevention: Using Evidence-Based Physical Activity Guidelines to Reduce Secondary Conditions in People with Spinal Cord Injury
- Focus on Secondary Condition Prevention
- The Training Corner January, 2010: Avoiding Inactivity in Arthritis
- Defining Secondary Conditions for People with Disabilities
- Focus on Secondary Condition Prevention: Osteoporosis Risk and Low Bone Mineral Density for People with Disabilities
- Focus on Secondary Condition Prevention: Exercise as a Way of Reducing Pain for People with Fibromyalgia
- Focus on Secondary Condition Prevention: Osteoporosis Risk and Low Bone Mineral Density in People with Spinal Cord Injury
- Focus on Secondary Condition Prevention: Decrease Secondary Condition Risk by Celebrating National Girls and Women in Sports Day with Exercise
- Focus on Secondary Condition Prevention: Universal Design and Accessibility Issues that Impact Health and Function for All
- Review of Effectiveness of Physical Interventions for SCI
- Focus on Secondary Condition Prevention: The Age of Empowerment: People with Disabilities Decreasing Their Risk of Secondary Condition Development
- A Protective Prescription for Individuals with Spinal Cord Injuries
- Gyms Need a Higher Level of Technology To Reach People with Disabilities
- Secondary Condition Prevention: Building Your Own "Health Empowerment Zone"
- Feeling Good: Exercising with Spinal Cord Injury
- No More Sores: Preventing Pressure Sores for People with SCI
- Pilates for Individuals with Spinal Cord Injury
- Exercise Program for Individuals with Spinal Cord Injuries: Tetraplegia VHS/DVD & Quick Series Booklet
- Exercise Guidelines for Clients with Lower Back Pain
- Exercise Program for Individuals with Spinal Cord Injuries: Paraplegia - Video & Quick Series Booklet
- Eating Well to Fight Arthritis
- Exercise Reduces Secondary Conditions in Children with Cerebral Palsy
- Exercise Induced Change in Psychological Well-Being among Spinal Cord Injury
- Focus on Secondary Condition Prevention: Lower Limb Amputation and Long-Term Prosthesis Use
- Assessment of holistic wellness program for persons with spinal cord injury
The following is Part I of a series of columns on the topic of pain as a secondary condition for people with disabilities. This month's column provides a general overview of pain experienced by people with spinal cord injury. Future columns will explore how pain affects people with different types of disabilities.
|Jennifer Rowland, Ph.D.|
There are two basic types of pain:
- Neuropathic Pain: also known as 'neuralgia' results from damage to the central or peripheral nervous system or from abnormal processing of central nervous system pain signals. This type of pain may present as a steady burning sensation, a 'pins and needles' feeling or as an 'electric shock.'
- Nociceptive Pain: may manifest as musculoskeletal pain, and can result from mechanical, thermal or chemical trauma. Nociceptors are sensory receptors that respond to these pain types, which are specifically: a) Mechanical: respond to excess pressure; b) Thermal: activated by extreme hot or cold temperatures above 45 degrees Celsius and below 5 degrees Celsius; c) Chemical: could be from externally ingested chemicals or a physiological chemical (ie, lactic acid that could cause pain following exercise)(Kandel, Schwartz, & Jessell, 2000).
Pain Prevalence for People with SCI
Pain prevalence for people with SCI varies widely among sources (33% to 94%) and depends on the survey sample and methods used in data collection (Demirel, Hilmaz, Gencosmanglu, & Kesiktas, 1998; Siddall, Taylor, McClelland, Rutkowski, & Cousins, 1999). It is estimated that as many as two-thirds of people with SCI report having chronic pain, and up to one-third of those reporting pain classify it as severe (Ehde, Jensen, Engel, Turner, Hoffman, & Cardenas, 2003; Finnerup, Johannesen, Sundrup, Bach, & Jensen, 2001; Siddall, Yezierski, & Loeser, 2002). Chronic pain has been shown to significantly increase with age (Putzke, Barrett, Richards, & DeVivo, 2003).
Recent research on adults with SCI provides evidence that pain adversely affects social integration, and that higher pain intensity is associated with a decreased ability to perform basic activities of daily living (Jensen, Hoffman, & Cardenas, 2005) and has a negative impact on quality of life (Budh et al., 2003; Rintala, Loubser, Castro, Hart, & Fuhrer, 1998; Turner & Cardenas, 1999; Turner, Cardenas, Warms, & McClellan, 2001). Siddall, McClelland, Rutkowski, and Cousins (2003) studied 100 people with traumatic SCI to determine prevalence and characteristics of pain within five years of injury. Fifty-eight percent of the sample reported severe or excruciating pain, with musculoskeletal pain being the most commonly reported pain type. Forty-one percent of the sample reported neuropathic pain at the injury level, whereas 35% reported pain below the lesion. Visceral pain, defined as originating from the body's viscera or organs, was only reported by 5%. Overall, 81% of those studied reported pain, but there was no relationship between pain presence and lesion level, complete or incomplete SCI, or injury type. These authors concluded that, among this sample, those with neuropathic pain soon after their injury were likely to have persistent pain which could be severe.
Measuring or Quantifying Pain
Finding ways in which to accurately measure pain and its effects on quality of life is especially important. Given improvements in medical care over the past few decades that have increased survival rates for people with SCI and made aging with SCI more common (Anson & Shepherd, 1996), the issue of accurate and complete pain measurement in SCI is very important for this population.
It can be difficult to distinguish neuropathic pain from nociceptive pain, and researchers in the Department of Pain Medicine and Palliative Care, Beth Israel Medical Center in New York developed a 6-item questionnaire to assist in making this distinction:
- Did the pain feel like pins and needles?
- Did the pain feel hot/burning?
- Did the pain feel numb?
- Did the pain feel like electrical shocks?
- Is the pain made worse with the touch of clothing or bed sheets?
- Is the pain limited to your joints?
Answering yes to questions 1-5 indicates neuropathic pain, whereas a yes to question 6 indicates nociceptive pain.
Another method of evaluating pain has been the McGill Pain Questionnaire. This form has been used in the clinic to describe subjective pain experiences, and involves a pain rating index, descriptive pain words, and pain intensity (on a 1-5 scale). However, it is not a pain measurement tool specific to identifying pain for people with SCI or other types of disabilities.
Although medications are one way of reducing pain, other strategies include improving education on ways to reduce pain by increasing self-efficacy, improving adherence to pain treatments, and identifying positive coping strategies (Ambrose et al., 2003; Cedraschi et al., 2004). Social support that involves a structure of receiving positive input from family members, friends, and caregivers, has also been shown to reduce pain (Hakkinen, 2004; Moskowitz et al., 2004).
Exercise is another potential prevention and different management tool to decrease pain among people with SCI. Future columns will explore how types of exercise can benefit people with SCI as well as people with other types of disabilities.
Encouraging Readers to Share Pain Experiences
If you have experienced pain as a secondary condition, or have advice for others regarding ways in which you have decreased your pain, please e-mail me, Dr. Jennifer Rowland, at firstname.lastname@example.org. These shared experiences could offer ideas for future column topics.