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2.3. Pain after spinal cord injury

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. In general, people can experience acute and chronic pain. Most people experience acute pain when they have a disease or injury to the body. It usually begins suddenly and acts as a danger signal telling you that something is wrong and that you need help. This acute pain can be severe or mild, but it usually goes away as the body heals. Chronic pain is like acute pain in that it can start suddenly. However, chronic pain differs because it can build up over time and continue long after the body heals.

Pain after Spinal Cord Injury
Acute pain is common after a spinal cord injury (SCI). The pain may occur as a result of the damage to the spinal cord, or it may occur from damage to other areas of the body at the time of injury. It is also common for many individuals with SCI to experience chronic pain. It can occur in areas where there is normal sensation, and it can occur in parts of the body where there is little or no feeling after injury. The pain is very real and may have a great impact on daily living. A person in pain has difficulty carrying out daily activities. If you have pain, you can take three steps to help improve your overall quality of life:

Pain Management
Pain management usually includes treatment with medications, modified activities or a combination of both. It may not be possible to completely stop the pain, but an effective pain management program can lessen the intensity of the pain.

Pain management can be a very difficult process. Many times it is hard to know what is causing the pain in individuals with SCI. You should talk with a doctor who knows about pain after SCI before you try any medications or methods of managing pain. It can take time to work out how to best manage your pain. An effective pain management program depends on the type of pain you have. Secondary overuse is often managed by modifying activities that use the joint or body part that is in pain. This may include limiting or stopping activities that make the pain worse. For example, it may help to limit pushing a wheelchair if you have shoulder pain. It may be necessary to switch from a manual to a power wheelchair.

It is recommended that you pace yourself during certain activities. Here are some examples on how to effectively pace your activities:

  1. List all activities that you frequently overdo that result in an increase in your pain or fatigue. For example, if typing on a computer tends to increase your pain, list "typing on a computer."
  2. When doing each activity on your list, make a note of the time that it takes for you to experience an increase in pain or fatigue. For example, make a note if your pain or fatigue increases after 30 minutes of typing on the computer.
  3. Set a time limit for doing the activity that is well below the point when you experience an increase in pain or fatigue. When you reach that time, stop and rest. For example, stop and rest after 15 minutes of typing on the computer.
  4. Return to the activity after your rest period. The time that you spend resting will vary. You want to have enough rest time for you to continue the activity as outlined in numbers 2 and 3.
  5. Do not get in a rush to complete any activity. You should slowly increase your endurance by increasing the amount of time that you spend doing the activity and always include adequate rest periods.

If you are unable to relieve your pain through activity modifications like pacing of activities, it may be necessary to use medication such as opiates or nonsteroidal anti-inflammatory drugs.

Keys to Success in Managing Pain

Pain Affects You
Pain not only affects the body, it also influences how you think and feel. As an individual experiencing pain, you probably have a hard time thinking about anything but pain. This negative thinking then affects your emotional responses. The fear that your pain might get worse if you do something may keep you from participating in enjoyable activities. Pain can also lead to feelings of anger or depression. Depression can make pain worse and result in social isolation.

If you are living with pain, there are some psychological approaches that you can take to help reduce your pain. You can learn to better cope with stress and overcome depression through professional counseling, although severe depression may require medication. Some techniques that you might learn through counseling include relaxation training, biofeedback and hypnosis. The Distraction technique may also help reduce chronic pain. When you have pain, it may increase when you are not active or you begin to relax such as before you go to sleep. This increase in pain occurs because you have time to focus on the pain. When you are participating in enjoyable and meaningful activities, your awareness of pain decreases. For example, when you are busy with work, school, or recreational activities, you are not as likely to focus on your pain.

Pain management can be very important in improving your overall quality of life. If you are in pain, talk with a doctor. Start first with the simple methods of reducing your pain. You may have to try several treatments before finding one, or a combination, that works for you. Do not treat yourself because you may have a serious health problem that may be causing the pain. Ultimately, the solution may not be a cure. You may not be able to live completely pain free. You may only be able to reduce your pain. But easing the pain may be enough for you to live a productive, satisfying life.

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