Overview

Understanding spinal cord injury (SCI)

The spinal cord is a bundle of nerves that descends into the bottom of the back and functions like a “superhighway” for information between your brain and the other parts of your body. It carries the information that enables you to move, experience touch, detect temperature changes, and coordinate the various functions in your body.¹

A spinal cord injury is damage to this important bundle of nerve cells. Most injuries don't damage the spinal cord all the way through. Instead, they are typically caused by a violent, severe blow that crushes or dislocates your vertebrae (your spine's bones), and they crush or tear the cord material in the process. Damage like this disrupts information flow through the superhighway.

Types of injury: complete vs. incomplete

Spinal cord injuries will impact individuals differently, based on the severity of the damage to the spinal cord. Medical practitioners will often classify these injuries in terms that are either complete or incomplete:²

• Complete injury: This is when all motion and sensation are eliminated below the level of the injury. There are no more signals that the brain can pass beyond the point where the spinal cord was injured. Individuals with a complete injury will not be able to experience either motion or feeling in the areas that are injured
• Incomplete injury: In this case, some signals can still travel through the injured area of the spinal cord. This means a person may still have some feeling, movement, or both, below the level of the injury. Incomplete injuries vary significantly, with some people recovering better than others

Levels of injury: tetraplegia and paraplegia

The effects of an SCI depend on where the injury occurred in the spinal cord. An injury higher up the spinal cord will affect more of the body.

• Tetraplegia (also called Quadriplegia): This occurs when there is an injury to the cervical spine (neck region), causing paralysis or loss of function in the arms, hands, trunk, legs, and pelvic organs
• Paraplegia: This occurs when there is an injury to the thoracic or lumbar spine (mid to lower back region), causing paralysis or loss of function in the trunk, legs, and pelvic organs while sparing the arms

Understanding central pain syndrome (CPS)

Central Pain Syndrome (CPS) is a lasting pain disorder that occurs when the central nervous system is injured or has some sort of dysfunction. The central nervous system consists of the brain and spinal cord and deals with sending, receiving and relaying pain messages to and from every part of the body.³

With CPS, the damaged nerves in the spinal cord or brain start to send faulty, chaotic signals. The brain, struggling to interpret this information, misreads the signals as pain. This means the pain isn't coming from a new problem in your hand or foot for example, but actually the pain generator is the nervous system itself. That is why the pain feels so real to your brain.

The many faces of nerve pain

Because CPS can come from faulty nerve signals, it can feel very different from other types of pain. People describe it in many ways, and you may experience one or several of these sensations. 

Common descriptions include:^2,3

• A constant burning, like being scalded
• Sudden stabbing or shooting pains
• Electrical shocks
• A persistent "pins-and-needles" feeling or tingling
• A deep, constant aching or a vice-like squeezing pressure

Common triggers for flare-ups

Many people find that their pain is triggered or made worse by specific things. This is because the nervous system is in a hypersensitive state. 

Common triggers include:

• Cold temperatures
• Light touch from clothing or bedsheets
• Movement
• Stress and strong emotions

The connection: why spinal cord injury can lead to nerve pain

Now that we've looked at SCI and CPS separately, let's review how the damage from a spinal cord injury (SCI) can lead to the strange and painful sensations of neuropathic pain.

A faulty alarm system in your nerves

Think of your nervous system as a complex alarm system for your body. After an SCI, this system can become damaged and overly sensitive, a state called Central Sensitisation. It’s like a fire alarm that has become faulty. Instead of only going off for a real fire, it now blares for something as minor as burnt toast or even just a puff of steam. Your nervous system starts sending intense pain signals to your brain in response to things that shouldn't be painful at all.

Another way to think of it is that the "volume dial" for pain in your brain has been turned up to maximum. 

This leads to two key experiences:

• Allodynia: When a light touch from bedsheets or clothing feels painful
• Hyperalgesia: When a minor bump causes an extreme, out-of-proportion pain response

Opening and closing the "Pain Gates"

A helpful way to understand how this pain can be controlled is the Gate Control Theory. Imagine there are "gates" in your spinal cord that pain messages must pass through to reach your brain. Pain signals try to open these gates. But other signals, like touch or pressure, can help close them. This is why rubbing a sore spot can make it feel better.

Most importantly, your brain can also help open or close these gates.

• Factors that open the gate: Feelings like stress, anxiety, and fear, or focusing all your attention on the pain, can hold the gates wide open
• Factors that close the gate: Positive emotions, relaxation, and distracting yourself with an activity you enjoy can help close the gates, reducing the amount of pain you feel

This means you have the potential power to learn techniques that could help you close your pain gates.

How to manage central pain

Successful management requires a multidisciplinary and multimodal approach, combining different strategies to create a personalised plan. This involves using a "toolbox" of medications, therapies, and other interventions to improve function and quality of life.^4,5

Medications that calm the nerves

The goal of medication for CPS is to calm the overactive nervous system, which is why traditional painkillers are often ineffective. 

Clinical practice guidelines recommend certain anticonvulsants and antidepressants as first-line treatments.^4,6

• Anticonvulsants, such as gabapentin and pregabalin, are anti-seizure medicines that work by reducing the excitability of damaged nerves that are sending false pain signals
• Antidepressants, including amitriptyline and serotonin-norepinephrine reuptake inhibitors (SNRIs such as duloxetine), help by boosting the brain's own natural pain-fighting chemicals, which helps to "turn down the volume" on pain messages 

Therapies for mind and body

Medication is just one tool in the box. A complete approach includes therapies that address both the physical and mental aspects of living with chronic pain. 

• Physical and occupational therapy (PT/OT) can help you find better ways to move and use equipment to prevent other aches and pains (like shoulder pain) that can make your central pain feel worse
• Psychological therapy, especially Cognitive Behavioural Therapy (CBT), is a key tool. CBT is not about convincing you the pain isn't real; it's about helping you retrain your brain's reaction to the pain, giving you practical skills to manage the thoughts and feelings that can open the "pain gate"

Additional and advanced options

• A transcutaneous electrical nerve stimulation (TENS) unit is a small, portable device that uses sticky pads on your skin to deliver a mild electrical tingle that can help block pain signals
• Acupuncture helps some people find relief by stimulating the body's pain control systems, and studies suggest it may provide relief for a subgroup of individuals with SCI⁷

For very severe pain that doesn't respond to other treatments, there are more advanced options. These can include implanted devices like spinal cord stimulators, which use electricity to mask pain signals, or drug pumps that deliver medication directly to the spinal cord. These are specialised treatments that you would explore with a pain management team. 

FAQs

Why do I feel pain in parts of my body that have no sensation?

This is one of the most confusing aspects of nerve pain after an SCI. The pain is very real, but it isn't coming from your limb. Instead, the injury to your spinal cord has damaged the "wiring." These damaged nerves can become overactive and send jumbled or false "pain" messages up to your brain. Your brain receives these signals and interprets them as pain, even though there is no new injury in your limb, and you may not have normal sensation there. It's like a faulty fire alarm that goes off even when there's no fire.

Will this pain ever be cured?

While researchers are actively working on ways to repair the spinal cord, which could one day provide a cure, current treatments focus on effectively managing the pain to improve your quality of life. There is no single "magic bullet," but by combining different tools, like medications that calm the nervous system, physical therapies, and psychological strategies, many people can significantly reduce their pain and its impact on their lives. Promising future therapies like stem cell treatments and advanced electrical stimulation are currently in clinical trials, offering hope for better treatments ahead.

Summary

A spinal cord injury (SCI) damages the nerve superhighway connecting the brain and body. A common, challenging result is Central Pain Syndrome (CPS), a chronic condition where the injured spinal cord sends faulty signals that the brain interprets as severe pain. This neuropathic (nerve) pain is often felt as burning, stabbing, or shooting sensations, even in areas with no normal feeling.

Management focuses not on a single cure but on a personalised "toolbox" of strategies to improve quality of life. This includes medications that calm the overactive nerves, like certain anticonvulsants and antidepressants, rather than traditional painkillers. This approach is combined with physical therapy to prevent other pain triggers and psychological therapies like Cognitive Behavioural Therapy (CBT) to help retrain the brain's response to pain signals. For severe cases, advanced options may be considered.