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Spinal Cord Injury (SCI)

There are about 240,000 patients with spinal cord injuries (SCI) in the Unites States; 86% of individuals with SCI report pain at 6 months post-discharge, with 27% of these individuals reporting pain that impacts most of their daily activities. Patients can have pain both at the level of spinal injury and at the level below the injury. Pain intensity is not associated with the magnitude of the spinal lesion, location of the lesion, occurrence of myofascial pain syndrome or the onset of pain. However, pain is usually more severe in patients with gunshot injuries.

Pain After a Spinal Cord Injury

Pain after SCI may be from different sources. These sources include neuropathic, musculoskeletal and visceral pain. Neuropathic pain after SCI is further divided into central and segmental pain. Central neuropathic pain often begins within weeks or months after injury. It is generally described as a burning, sharp or shooting pain. Patients feel pain at or below the level of injury in areas where there is partial or complete loss of sensation to the touch. Central pain is believed due to deafferentation caused by spinal cord injury. Astrocytic activation in the spinal cord, upregulation of chemokines, and hyperexcitability of wide dynamic range neurons in the spinal dorsal horn rostral to the lesion have been suggested to cause the neuropathic pain after SCI. Segmental pain often occurs around the border of injury. It usually develops within the first few months following an injury. Allodynia and hyperalgesia are common. Nerve root entrapment could lead to severe segmental pain. Patients may describe stabbing or sharp pain or a band of burning pain at the level of injury. Syringomyelia, with a cyst ascending from the level of the SCI, may occasionally cause central pain.

Musculoskeletal pain in this group of patients may be due to muscle spasms below the level of SCI and arthritis in disused joints. Pain is generally described as dull or aching. It is usually worsened by movement and eased with rest. Visceral pain may begin a short time following SCI. It could be related to the constipation and urinary retention due to sphincter dysfunction. It may occur in the abdomen, above or below the level of injury. The pain is often described as cramping, burning and constant.

Pain Management After a Spinal Cord Injury

Pain management after SCI is difficult. Pharmacological and rehabilitative procedures are effective in only about 38% of patients. However, the initial work up should be aiming at identifying the pain source. Different kinds of pain may respond differently to treatments. For neuropathic pain, medications such as gabapentin, amitriptyline and nortriptyline, may ease the pain in some patients. Intravenous lidocaine may provide temporary pain relief. Intrathecal baclofen therapy may reduce chronic musculoskeletal pain associated with spasticity and improve the patient’s quality of life. Intrathecal morphine and clonidine offer limited help to relieve the pain. Thalamic stimulation and motor cortex stimulation have been reported to be effective in some cases. Use of the spinal cord stimulator lacks long-term efficacy for the relief of spasticity and pain in the SCI and is believed not to be cost-effective. Dorsal root entry zone lesions and dorsal rhizotomy have also been used with limited success. Appropriate management of bowel or bladder dysfunction may help ease visceral pain. If an ascending syrinx is present, surgical drainage may be effective in relieving the pain.

Meet the FLPNR Team

  • Richard Adkins, MD
  • Hoang (Wayne) T. Vu, D.O.
  • Lourdes Varela–Batista, M.D.
  • Vinh-Loc Nguyen, P.A.
  • Irene Aponte Moreno, N.P.
  • Sunny Park, N.P.
Anesthesiology Specialist in Ocala, FL Doctor of Osteopathic Medicine in Ocala, FL Physician in Ocala, FL Physician in Ocala, FL Nurse Practitioner in Ocala, FL Nurse Practitioner in Ocala, FL
Anesthesiology Specialist in Ocala, FL

Richard Adkins, MD

Anesthesiology Specialist

Dr. Richard Adkins has been in practice for more than 30 years. His specialty is in anesthesiology and pain medicine.

Doctor of Osteopathic Medicine in Ocala, FL

Hoang (Wayne) T. Vu, D.O.

Dr. Hoang (Wayne) T. Vu is board certified by both the American Board of Pain Medicine and the American Board of Physical Medicine and Rehabilitation. Dr. Vu earned his degree of Doctor of Osteopathic Medicine from Touro University College of Osteopathic Medicine in California in 2003.

Physician in Ocala, FL

Lourdes Varela–Batista, M.D.

Dr. Varela is a fellowship trained pain specialist and board certified PMR expert. Her specialities include physical medicine and rehabilitation and interventional pain medicine. She received her undergraduate degree from University of Puerto Rico and completed her medical degree from New York Medica College. Dr. Varela completed her physical medicine and rehabilitation residency at University of Texas Health Science Center San Antonio.

Physician in Ocala, FL

Vinh-Loc Nguyen, P.A.

Vinh-Loc Nguyen is a NCCPA certified physician assistant and is licensed by the State of Florida Department of Health. He received his Bachelor of Science degree in microbiology and Bachelor of Arts Degree in economics from University of Florida in 1994. He had a successful career in the financial industry before returning to his true passion for medicine.

Nurse Practitioner in Ocala, FL

Irene Aponte Moreno, N.P.

Ms. Irene Aponte Moreno is an Adult-Gerontology certified Nurse Practitioner and licensed by the State of Florida Department of Health. In 2014, she received her Master of Science degree in Nursing from the University of South Alabama. She completed her Bachelor of Science degree in Nursing from Jacksonville State University in December of 2006. In 2003, she received an Associates of Arts degree from Southwestern Michigan College. She also completed an Associate degree in Informatics from the University Institute Antonio Jose de Sucre located in Lara State, Venezuela.

Nurse Practitioner in Ocala, FL

Sunny Park, N.P.

Ms. Sunny Park is an AANP and ANCC certified Advanced Registered Nurse Practitioner, licensed by the State of Florida Department of Health. She graduated with Summa Cum Laude with Bachelor of Arts in Drawing from Southern Illinois University in 1999. She pursued nursing career and graduated with Associate of Science in Nursing in 2007 and started working as a registered nurse in Cardiovascular ICU in St.Luke’s Medical Center. She continued with her education and graduated with Magna Cum Laude obtaining Bachelor of Science in Nursing in 2010 from Cardinal Stritch University. During her nursing education, she was awarded multiple scholarships including the Lamplight scholarship by Milwaukee Nurses Association.


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