Pain classification following spinal cord injury: The utility of verbal descriptors

Abstract

Objectives: To determine the predictive utility of verbal descriptors to distinguish between pain types following spinal cord injury (SCI). Design: Cross-sectional. Setting: USA. Methods: Participants (n=29) completed the Short Form ± McGill Pain Questionnaire (SF-MPQ) for each pain site reported. A total of 64 pain sites were reported with 80% of the sample reporting multiple pain sites. Each pain site was categorized using three di erent SCI pain classi®cation schemes. The predictive utility of verbal descriptors to distinguish between pain types was examined statistically using (1) each word separately, (2) a combination of words (ie, the SF-MPQ total subscales, the number of words chosen on each scale), and (3) discriminant function analysis.Results: There was a substantial overlap in the use of verbal descriptors across pain types. Few di erences across pain types were found for endorsement of individual words, and di erences across pain types were not found for any of the word combination scores. The majority of the verbal descriptors did not enter the step-wise discriminant functions for each SCI pain classi®cation scheme, however,`tingling' and`aching' showed modest predictive utility for neuropathic and musculoskeletal pain, respectively. Correct classi®cation was in the low range (ie, 39% to 82%, average=60%, with a 33% chance level). All three pain classi®cation schemes showed the same general pattern of results. Conclusion: In general, verbal descriptors alone o ered marginal utility with regard to identifying speci®c pain types following SCI. Future directions alone and implications are discussed.

Shoulder pain following tetraplegia: a follow-up study 2–4 years after injury

“…9 'Aching' was chosen by one-third of participants. Aching' may describe musculoskeletal pain, 9,22 but was found by Cardenas 10 to describe both musculoskeletal and SCI pain (defined as neurologic pain below the lesion level in an area without normal sensation). 'Tingling' has been considered a descriptor for neuropathic pain 9,10,22 and was not a common choice in this study.…”

“…These words may describe or relate to trauma or inflammation to various structures within the shoulder joint or the capsule as they may describe pain of musculoskeletal origin. 9,18,19,22 Pain in the upper trapezius region was described as 'sharp', 'pinching', 'pulling', 'hot' and 'tender'. Descriptors of heat may refer to neuropathic pain referred from the cervical spine.…”

International Spinal Cord Injury Pain Classification: part I. Background and description

“…The presence of at-level SCI pain is suggested by characteristics such as: 4,5,9,16,20,21 Sensory deficits within the pain distribution Allodynia or hyperalgesia within the pain distribution Endorsement of one or more of the following pain descriptors: 'hot-burning' , 'tingling' , 'pricking' , 'pins and needles' , 'sharp' , 'shooting' , 'squeezing' , 'painful cold' and 'electric shock-like' Pain occurring in a segmental pattern as described above, which is thought to be due to syringomyelia, should be classified as at-level SCI pain or, more specifically (using tier 3 entries), at-level SCI pain due to/associated with syringomyelia. Note that the current NLI often is higher than the original NLI in patients who develop syringomyelia following a SCI.…”

“…Neuropathic pain that occurs in this distribution and that cannot be attributed to the spinal cord damage should be classified as other (neuropathic) pain. The presence of below-level SCI pain is suggested by characteristics such as: 4,5,9,16,[20][21][22] Sensory deficits within the pain distribution Allodynia or hyperalgesia within the pain distribution (for persons with incomplete injury) Endorsement of one or more of the following pain descriptors: 'hot-burning' , 'tingling' , 'pricking' , 'pins and needles' , 'sharp' , 'shooting' , 'squeezing' , 'painful cold' and 'electric shock-like' Below-level SCI pain can occur in persons with complete injuries and in those with incomplete injuries. Neuropathic pain associated with cauda equina damage is radicular in nature, and therefore defined as at-level SCI (neuropathic) pain, regardless of distribution.…”

Gender related differences in pain in spinal cord injured individuals

“…However, a recent study has investigated the use of pain descriptors when classifying SCI pain and concluded that verbal descriptors alone are not su cient for pain classi®cation. 25 In non-SCI populations, women often report more numerous pain locations than men 17,19 and more severe pain. 18 This was not the case in our study, where no di erences were found.…”