Your Pain
Know about your pain
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Why do we experience pain?
Pain is normally generated when a potentially harmful stimulus (noxious), caused by heat, tissue damage or inflammation, activates high threshold receptors that send messages along the spinal cord to the brain. Different nerve pathways and chemical substances are involved with the control of pain, and the balance of these mechanisms often changes after a spinal cord injury.
A strong stimulus triggers the nerve
A message reaches the spinal cord then travels to the brain
The messages are relayed to different parts of the brain
This is the point when you start experiencing pain
Pain gate mechanism
At various levels of the spinal cord and in the brain, there is a natural gate that filters information to ensure you only become aware of sensations when they reach a critical level or threshold.
The gates, when closed, help to turn down the volume of information received by the brain.
If these gates are not closed, your brain can become confused due to too much information.
Effects of spinal cord injury on pain
Due to damage to the nerves after a spinal cord injury, the gates struggle to close. The spinal cord itself becomes sensitised or hyperexcitable to this sensory information.
The damaged spinal cord tries to reorganise and rewire itself after injury. Faulty rewiring at the injury site causes the nerves to fire off in an uncontrolled manner, even when triggered by a stimulus that is not usually painful.
For example, a light brushing touch may be experienced as an electric shock or burning pain.
Good news!
The pain gates in your nervous system are found not only in the spinal cord but also in the brain. You can retrain the brain to turn down your pain.
We know there are pathways coming down from the brain to the spinal cord that control these gates. The release of certain chemicals excites the pain pathways, so the gates open up. Other chemicals close the gates.
You can use physical, psychological and medical strategies to turn down the
pain volume.
Diaries
Diaries
Keeping a Pain and Activity Diary will provide you and your healthcare professionals with a good understanding of your pain experience and what influences your pain to be able to manage it better. It is recommended that you complete the pain and activity diary up to 14 days to identify any pattern or trend.
In addition, your mood and/or sleep pattern can affect your pain. If you are experiencing substantial problems with your mood and/or sleep, keeping a Mood and/or Sleep Diary will help to inform your treatment. For example, your thoughts and emotions can either increase or decrease your pain perception, acting like a volume control dial in your brain.
You can download an interactive pdf version of the Pain, Activity, Mood and Sleep Diaries below.
You can download editable pdf version of the diary or create a digital diary on your device using the SCI Health Toolkit app.
[ Mood diary image and link to be applied once approved ]
Please note: Diaries must be downloaded to be completed – they cannot be filled in online
The SCI Health Toolkit App
The SCI Health Toolkit app provides you with a bladder and fluid diary in your pocket, along with all of the other diaries available on The Health Maintenance Toolkit website.
You can quickly and easily track and monitor key bodily functions and activities using the interactive and simple to use diaries.
Toolbox
Pain management toolbox
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Pain management toolbox
Since there are different types of pain and a range of contributing factors, there is no one-size-fits-all approach.
A single strategy, for example, taking medications, may not be as effective as using a number of strategies at the same time. You and your doctor may need to try a combination of medications, exercise, pacing of activities, relaxation and other treatments, including psychological treatments.
Think about using the below eight strategies to manage your pain.
Important Note
It is unlikely that changing just one strategy will fix chronic pain. Consult your doctor to find the best approach for you.
The eight strategies
1. Healthcare team approach
It is important to learn to work with the different members of your healthcare team to get the best results. When it comes to communicating with your team about pain, it is helpful to understand the type of information your healthcare professional needs to know. This information helps them to identify your pain to formulate your management plan.
A comprehensive interdisciplinary pain evaluation involves assessing the following factors:
- Location and type of pain
- Circumstances associated with pain onset
- Rating of the intensity of your pain
- Impact of pain on your daily activities, mood, rest and sleep
- Any important medical history and presence of warning signs
- Effectiveness of treatment (medications and other strategies) on your pain
- Adverse effects from medications, e.g., nausea, constipation and poor concentration
- Factors influencing your adherence to treatment
- Goal planning to determine what you would like to do if your pain was better controlled.
Sometimes you need to educate your healthcare team about spinal-related health issues so it is important to know where to direct them. See further resources section on page.
Did you know?
It is normal for pain to fluctuate in intensity during the day or from one day to the next. However, when pain suddenly intensifies or the location or characteristics change, it needs to be checked out.
“I am going to start keeping a pain diary to record what is going on.”
Person with spinal cord injury
What does research tell you?
The assessment and treatment of pain in people with a spinal cord injury relies on a holistic, unified team approach to best utilise the full range of medical and non-medical strategies.
Members of your pain management team can include:
Members of your pain management team can include some or all of the following specialists, each with a different role in helping you manage your pain.
GP or local doctor
Physiotherapist
Occupational therapist
Clinical psychologist
Medical specialists
Social worker
Recreational therapist
Nurse
Other members
Your GP is often the first point of contact.
GP or local doctor
Your GP is often the first point of contact.
Physiotherapist
Gives advice regarding exercise, fitness, postural re-education and ways to relieve pain, and also provides training in community mobility skills.
Occupational therapist
Helps adapt your home and work environment and teaches you strategies to make daily functioning easier.
Clinical psychologist
Teaches you different strategies and techniques to think about and cope with pain, e.g., relaxation, mindfulness.
Medical specialists
They specialise in the diagnosis, treatment and/or management of pain, e.g., spinal rehabilitation specialist, pain specialist, neurologist, neurosurgeon or orthopaedic surgeon.
Social worker
Provides practical advice, support and help with different aspects of your life affected by your pain, such as work, relationships, family life, income and housing.
Recreational therapist
Plans, coordinates and implements recreation and leisure-based activity programs to support and enhance your psychological, social, emotional and physical wellbeing.
Nurse
Helps with troubleshooting bowel and bladder issues causing pain.
Other members
Include practitioners of complementary and alternative medicine. Techniques include acupuncture, chiropractic, massage therapy, naturopathic medicine and reiki. However, most techniques lack evidence in terms of effectiveness. It’s important to be aware of the risks of natural, alternative or holistic treatments.
Please advise your clinician if you try a complementary therapy.
Remember
It is normal for pain to fluctuate in intensity during the day or from one day to the next. However, when pain suddenly intensifies or the location or characteristics change, it needs to be checked out.
Keep a pain diary to track any changes in your pain intensity.
2. Medications
Medications for musculoskeletal pain
Simple analgesics
Panadol works to reduce pain and fever by reducing the release of chemicals that are linked to pain and inflammation.
Non-steroidal anti-inflammatory drugs
Aspirin, ibuprofen and Naproxen reduce pain by modifying the inflammatory response and blocking the activity of a certain chemical in your body.
Muscle relaxant (anti-spasticity) medications
Diazepam (Valium), Baclofen (Lioresal) and Tizanidine (Zanaflex) can be effective for spasm-related pain
Medications for neuropathic pain
Anticonvulsant medications
Pregabalin (Lyrica) and Gabapentin (Neurontin) work by reducing the excitability and the abnormal firing in damaged nerves after spinal cord injury.
Antidepressants
Duloxetine (Cymbalta), Venlafaxine (Effexor) and low-dose tricyclic drug Amitriptyline (Tryptanol, Endep), work by increasing the amount of chemicals responsible for closing the pain gate and ultimately reduce the volume of pain messages being sent to
your brain.
Narcotics (Opiates)
Opiate medications, such as morphine and codeine, may be used to treat moderate to severe pain arising from musculoskeletal or neuropathic conditions. They bind to opioid receptors in the central nervous system which changes the way the brain perceives pain.
In people with a spinal cord injury, opioid medications become less effective over time and often result in unpleasant and severe side effects.
A common problem with opioid medications is the development of addiction and tolerance. Over time you no longer get the same pain-relieving effects – no matter how high the dose. Long-term, high-dose use can have the reverse effect.
Common side effects of opioids include:
- Constipation
- Drowsiness
- Blurred vision
- Dry mouth
- Headache
- Nausea
- Brain fog
- Memory loss.
Other serious side effects are breathing difficulty, worsening of snoring, lowered immunity, depression, overdose and death.
Now I’m not on any pain medication, I’m much happier because I have a clearer head and my memory has improved.
Person with spinal cord injury
What does research tell you?
A number of medications have proven effective in treating chronic pain disorders, and their use separately or in combination may help to control your pain.
Pain management strategies used by people with a spinal cord injury included:
Painkillers
Other medications
more than
50%
Anticonvulsants
33%
33%
Opioids
21%
Antidepressants
16%
Painkillers
Other medications
more than
50%
Anticonvulsants
33%
33%
Opioids
21%
Antidepressants
16%
2015 Rural Spinal Cord Injury Project survey of 681 people living with spinal cord injury in rural NSW
3. Physical activity and exercise
It is essential to have a healthy body and mind for ultimate pain control. Exercise can help reduce both neuropathic and musculoskeletal types of pain by releasing natural opioid-like chemicals called endorphins. By using the body’s own pain-relieving chemicals, you can help reduce your pain and improve how you feel.
Exercise strengthens your muscles to help support your bones and joints. This, in turn, improves your posture and ability to perform everyday activities with less effort. After a spinal cord injury, regular exercise helps to maintain muscle conditioning, balance, strength and function.
A physiotherapist can develop an individualised exercise plan for you, including:
- Modifying your activities
- Stretching
- Range-of-motion exercises
- Strengthening exercises for strong core and postural muscles.
A transcutaneous electrical nerve stimulator (TENS) has been shown to be effective for treating musculoskeletal pain as it blocks the pain signals from the areas of nerve damage.
Did you know?
Exercising for as little as 3-10 minutes at moderate to high intensity produces significant amounts of endorphins.
What does research tell you?
Engaging people with chronic pain in physical activity improves their pain, physical function as well as quality of life.
4. Pacing
Reduced activity leads to weakening of muscles, stiff joints and decreased fitness which results in pain flaring up more quickly. An unhelpful activity pattern involves cycles of over- and under-doing activities. Over-doing results in more pain so you have to cut back your activity level. The result is like being on a rollercoaster:
Activity pacing or pacing relates to planning for an activity. It is helpful to break down an activity into smaller chunks. The next step is to build up activities over time.
Planning to pace
- Think about the things you enjoy doing but have had to cut back or stop due to pain. Brainstorm ways to gradually introduce them back into your daily routine.
- Start small and build up gradually towards your goals. Increasing your activity by 10-20% per week will give you long-term results.
- Set a very specific routine and stick to it – this will help you achieve your goals.
5. Thoughts and emotions
The way we think and feel has a direct impact on our pain experience. The brain perceives information about pain location, type and intensity. At the same time, pain messages also travel to parts of the brain that deal with thoughts and emotions.
Your thoughts and emotions either increase or decrease your pain perception, acting like a volume control dial in your brain. If you feel unwell, anxious and stressed, messages from the brain cause the pain gates to open wide. As a result, more pain messages get through and your pain experience gets worse.
In some situations, your pain becomes less of an issue, especially when you focus on something else, e.g., your favourite hobby, watching a movie, listening to music or exercising. These activities help stimulate the body’s natural feel-good chemicals and distract your mind. As a result, overactive nerve impulses are reduced and the pain gates close.
Unhelpful thoughts | Unhelpful thoughts make your pain worse and reduce your ability to cope with the pain. They can make you feel worried, for example., ‘There must be something terribly wrong to cause this pain.’ Negative thoughts can also undermine your confidence, for example, ‘I cannot cope with this.’ Both are common in people experiencing chronic pain. The good news is that thoughts can be changed which help reduce your pain and increase your coping ability. Two different ways to deal with unhelpful thoughts:
|
Planning and goal setting | Planning and goal setting are important to help you achieve what is important, despite the pain. Work out what really matters to you then set achievable goals, break down your goals into smaller, bite-size pieces that are achievable in a daily or weekly timeframe. |
Desensitisation | Desensitisation involves learning to focus on the pain but then letting it blend into the background and not focussing your attention on it. |
Relaxation and meditation | Relaxation and meditation can assist in reducing muscle tension and stress that exacerbate pain by activating pain-reducing brain chemicals. |
What does research tell you?
Pain catastrophising (which refers to believing that something is far worse than it actually is) can magnify pain symptoms and increase depression, sense of helplessness, anxiety and loss of function.
6. Sleep
Chronic pain impacts your sleep. A lack of sleep affects your brain’s ability to deal effectively with pain and has a negative effect on your mood, energy levels and ability to concentrate.
Effects of poor sleep
Did you know?
- During sleep many active processes occur that are essential for maintaining good health.
- Alcohol interrupts your sleep cycles and causes disrupted sleep and early awakening. Drinks like coffee and soft drinks cause problems with getting to sleep and staying asleep.
Sleep after a spinal cord injury
Sleep patterns often change after a spinal cord injury affecting the amount and quality of sleep. You might be awake longer, wake up more frequently and have reduced rapid eye movement (REM) sleep. REM sleep is the deep restful sleep when important body processes occur including body rest and repair – it is also when you dream.
Certain factors disrupt sleep patterns,
such as spasms, changing position in bed
and overnight bladder care.
People with higher injury levels are likely to have more problems producing a natural chemical known as melatonin. A lack in melatonin makes it difficult to get to sleep and/or stay asleep.
More than 60% of people with quadriplegia have obstructive sleep apnoea (OSA). Common signs and symptoms include:
- Daytime sleepiness
- Loud snoring
- Episodes of stopping breathing during sleep
- Sudden waking with gasping or choking
- Awakening with a dry mouth or sore throat
- Morning headache
- Poor memory
- Problem with concentration.
A respiratory and sleep physician treats OSA with the support of your GP.
Treatment options for sleep apnoea
- Healthy lifestyle changes
- Breathing devices
- Mouthpieces
- Therapy for mouth and facial muscles
- Implants
- Surgical procedures.
What does research tell you?
Sleep and pain are interrelated but research has shown that poor sleep is more strongly linked with chronic pain than the other way around.
Tips for having a good night’s sleep
Good quality sleep is the result of good sleep habits, also known as sleep hygiene. Consider the following strategies to help you get a good night’s sleep:
- Make your bedroom a sanctuary for sleeping
Don’t set up your bedroom like an office or entertainment room. Instead, make sure you have good ventilation, fresh air, a constant comfortable temperature and you create a quiet space without TV or video games. - Have a set routine that symbolises sleep for you
Relax before going to bed, listen to relaxing music or do mindfulness exercises. - Aim for gentle exercise
Exercise every other day for good quality sleep. Avoid exercising just before bedtime. - Avoid caffeine
Caffeine after 3pm can increase your alertness and make it more difficult to get to sleep.
- Avoid alcohol
Alcohol initially makes you feel drowsy but then increases the likelihood of waking up in the early hours of the morning. - Try relaxation strategies
Do deep breathing exercises, progressive muscle relaxation or mindfulness meditation for 15 minutes before going to bed to help you relax. - Distract your mind from the pain
Pain can be particularly severe overnight. Listen to music, the radio or an audiobook to keep your mind off the pain. - Practice desensitisation
Learn to focus on the pain but teach yourself to let it blend into the background. As you change your focus, you will feel less distress. Desensitisation can be a particularly helpful strategy for coping with neuropathic pain.
7. Fatigue
Things to consider in understanding and managing fatigue
The energy bank
You have a certain amount of energy in your energy bank so think carefully about how to spend your energy currency by planning your everyday activities.
Triggers
Understand what triggers fatigue as increased awareness will give you more control. Triggers of fatigue include overdoing an activity, eating an unhealthy diet and poor sleep patterns.
Reduce strain
Minimise physical stress and strain on
your body.
It’s a question of balance
Do not let your pain or fatigue levels dictate what you do. Balance periods of activity with rest. Stick to a level of activity you can easily cope with then gradually increase your activity level.
Communication
Be confident when communicating with others about your pain and fatigue and the impact on your everyday life.
Relaxation and meditation
Activate pain control pathways from the brain to reduce pain.
Planning tips
Take time to plan and order your activities. Perform more challenging tasks earlier in
the day when you feel fresh and have
more energy.
The right fuel
Eat a nutritious balanced diet to improve your energy levels.
Did you know?
Strategies for managing chronic pain, such as developing a pacing plan and activity plan, are also effective for managing fatigue.
8. Lifestyle and nutrition
Good nutrition is important so your body functions well. After a spinal cord injury your body’s nutrition needs change and good nutrition becomes even more critical.
Benefits of having a good and healthy diet with good nutrition
- Stay healthy
- Keep your skin in good condition
- Improve bladder and bowel function
- Maintain a healthy weight
- Reduce your pain.
Did you know?
Weight loss and good nutrition can reduce pain.
Maintaining a healthy weight is especially important after a spinal cord injury. It is also a crucial part of your pain management program. Gaining weight makes you feel lethargic and aggravates painful conditions such as arthritis, low back pain, shoulder, wrist and elbow pain, and carpal tunnel syndrome (nerve compression at wrist).
Being overweight causes problems with mobility and transfers, leads to muscle and joint strain, and changes the suitability and fit of your equipment. At its worst, being overweight impacts your ability to be independent when carrying out daily tasks.
Quiz
Quick quiz
You may wish to see how much your knowledge has grown by taking this quick quiz.
Manage problems
Management of pain problems
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Manage a problem ‘just-in-time’
Serious complications can arise if pain-related problems are not managed in a timely way.
In the long term, these issues can lead to:
- Physical deconditioning and reduced activity levels
- Interference with your mood and sleep
- Increased reliance on medications
- Resorting to unhelpful or destructive strategies, such as taking illicit drugs or excess alcohol
- Social withdrawal.
‘Just-in-time’, or the right care at the right place at the right time, helps you manage your pain. As a result you will maintain your quality of life, independence, health and wellbeing.
Be proactive and take responsibility for managing your own health risks
This involves:
- Education to help you understand how your spinal cord injury affects your pain perception and learn about the latest research findings.
- Becoming a partner in decision-making and learning to problem solve with your doctor and health professionals.
- Developing an individual pain self-management program that works for you.
- Engaging in ongoing health and wellness activities. This includes:
- Exercising regularly
- Maintaining a healthy weight to reduce load on your shoulders, arms and hands
- Using medications as instructed by your doctor
- Incorporating regular relaxation, meditation and mindfulness techniques into your daily life.
Nature of pain
Pain can be acute or chronic in nature
Acute pain
Pain that occurs immediately after an injury, disease or surgery. Acute pain can be severe, but usually gets better within about 3 months as the body heals itself from the trauma.
Acute pain is important for our survival because it helps to protect us from danger.
Chronic pain
When pain persists for longer than 6 months, we reclassify it as chronic pain. There are different mechanisms that generate and maintain chronic pain.
Chronic pain can be present even after injured tissues have healed.
Important notes
Chronic pain is different to acute pain. Chronic pain responds differently to treatments for acute pain. In fact, treating chronic pain the same way you treat acute pain doesn’t work.
Pain can be categorised as follows: Nociceptive pain and Neuropathic pain.
Nociceptive pain arises from tissue damage that is sensed by specific pain receptors, called nociceptors. There are several different types of nociceptive pain:
- Musculoskeletal pain, e.g., shoulder pain
- Visceral pain from internal organs, e.g., abdominal pain
- Other nociceptive pain, e.g., autonomic dysreflexia headache.
Neuropathic pain arises due to direct damage to the spinal cord and nerves resulting in:
- At-level neuropathic pain, e.g., band-like pain felt at level of spinal injury
- Below-level neuropathic pain, e.g., pain well below spinal level in your legs
- Other neuropathic pain, e.g., carpal tunnel syndrome due to median nerve compression at the wrist.
Common types of pain
What does research tell you?
Pain can be categorised as follows: Nociceptive pain and Neuropathic pain.
Nociceptive pain arises from tissue damage that is sensed by specific pain receptors, called nociceptors.
There are several different types of nociceptive pain:
- Musculoskeletal pain, e.g., shoulder pain
- Visceral pain from internal organs, e.g., abdominal pain
- Other nociceptive pain, e.g., autonomic dysreflexia headache.
Neuropathic pain arises due to direct damage to the spinal cord and nerves.
Neuropathic pain can result in:
- At-level neuropathic pain, e.g., band-like pain felt at level of spinal injury
- Below-level neuropathic pain, e.g., pain well below spinal level in your legs
- Other neuropathic pain, e.g., carpal tunnel syndrome due to median nerve compression at the wrist.
Musculoskeletal pain is more prevalent in people with spinal cord injury who:
- Are older (aged over 60 years)
- Have been injured for less than 5 years or more than 20 years.
84%
of individuals reported pain as an issue
Did you know?
It is normal for pain to fluctuate in intensity during the day or from one day to the next. However, when pain suddenly intensifies or the location or characteristics change, it needs to be checked out.
Musculoskeletal pain
Musculoskeletal pain refers to conditions affecting muscles, bones and joints.
Pain location: It is common to feel pain in an area where the nerves have not been damaged, either above the level of your spinal cord injury or below the level, if you have an incomplete injury with preserved sensation.
Pain description:
Dull, sharp, tender, aching.
Things that make pain worse:
Certain body positions or movement, such as lifting to transfer, driving, pushing a wheelchair, exercise or sport.
Things that reduce the pain:
Rest, changing position, certain medications, and equipment changes.
Common types of musculoskeletal pain are shoulder pain, wrist arthritis, neck or back ache and muscle spasms.
Visceral (internal organ) pain
Pain location:
Abdomen, chest or pelvis.
Pain description:
Dull, cramping, aching, colicky (experiencing severe pain in the abdomen), comes and goes, poorly localised.
Things that make pain worse:
Bladder infection, bladder/kidney stones, constipation, gall stones, heartburn or
acid reflux.
Things that reduce the pain:
Treating infections with antibiotics,
adjusting your bowel regime to allow
for proper emptying.
Causes of visceral pain include:
Bloating, constipation, cramping and
bladder infection.
Neuropathic pain
Neuropathic pain refers to pain caused by damage or disease affecting the nervous system.
Pain location:
It is common to feel neuropathic pain at the level of your spinal cord injury and/or below the level of your spinal cord injury in an area of abnormal or absent sensation. Nerve pain may also occur above the level of your spinal cord injury due to direct nerve compression at your wrist or elbow from pressure and overuse. Pain may be felt in the feet, legs, buttocks, abdomen, trunk, hands, arms and shoulders, depending on the level of your spinal cord injury.
Pain description:
Hot, burning, shooting, stabbing, electric shocks, icy/cold, squeezing, constricting, crawling, tingling or pins and needles.
Things that make pain worse:
Bladder infection, constipation, fatigue, stress.
Things that reduce the pain:
Medications, being distracted, gentle exercise.
Check if you have a problem
Check if you have a problem
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Quick Health Check
If you are experiencing a health issue, to support you to identify the problem, check the seriousness of the problem and understand what action to take to manage it, we have provided easy-to-use tools to help you.
The Tools
The Quick Health Check is an automated version of the five following tools. These tools work together to help you with your pain.
- Checklist
Answer a few simple questions to help you to quickly identify a problem - Warning Signs
Check whether you have a serious problem that needs immediate attention by a healthcare professional - Severity Scale
Quickly assess how severe the problem is - Interference Scale
Select one number to determine how much the problem interferes with your daily life - Action to Take
The severity and interference scale ratings combine to provide you with the recommended action you need to take to manage the problem.
You can use the 5 manual tools below if you prefer this approach to using the automated Quick Health Check in the top right-hand corner of the page.
1. Checklist
Check if you have a problem
If you answer ‘yes’ to any of the questions below, refer to the Severity scale to see whether your problem is mild, moderate or severe, and then the interferance scale and action to take table, to understand whether you can self-manage or whether you need to manage with the support of a healthcare professional.
Have you experienced any pain in the last month (you may experience more than one type of pain in different parts in your body)? If yes:
- Where is the pain located?
- Is the pain above, at or below the level of your spinal cord injury
- What does your pain feel like?
- Is the pain dull or aching?
- Is the pain burning, icy cold, electric, pins and needles, sharp, shooting, squeezing?
- How does your pain behave?
- What things make it worse?
- Is the pain related to activity, posture, does it change with rest?
- Is the pain constant or intermittent?
- Is the pain worse at night?
- Is the pain related to constipation?
- How would you rate your pain on a scale of 0 (no pain) to 10 (worst imaginable pain)?
- Has your pain changed recently or have you noticed any other changes, such as feeling unwell?
- Have you noticed any new signs or symptoms that are alarming, such as loss of muscle strength or sensation, increased spasms, episodes of autonomic dysreflexia?
- How is your pain impacting on your daily activities, mood, rest and sleep?
- Are your current medications and/or other treatments helping to manage your pain?
2. Warning Signs
Warning signs, also known as red flags, refer to clinical indicators of possible serious underlying conditions associated with new pain or worsening of existing pain. Red flags require further medical investigation and possible specialist referral, and may include any of the following:
- New pain with different characteristics or a stable pain that suddenly gets worse without any obvious cause
- Any recent change in bowel function, such as nausea, bloating, abdominal pain, constipation, bowel accidents, rectal bleeding
- Changes in your level of sensation, loss in muscle strength or a marked increase in muscle spasm
- Pain associated with autonomic dysreflexia
- Any change in bladder function, e.g., frequent urinary tract infections, bladder leakage, difficulty emptying
- A new area of skin breakdown
- Pain associated with fevers and chills
- A recent fall or trauma prior to the
pain developing.
Yellow flags refer to psychological and social indicators suggesting increased risk of developing long-term distress, disability and pain affecting your independence, quality of life and ability to effectively manage and cope with your pain on a daily basis. These may include the following:
- Alcohol/substance abuse
- Depressive disorder
- Unhelpful thoughts
- Opioid overuse/dependence.
If you experience any of these issues there may be a serious problem requiring further investigation – seek medical attention immediately
3. Severity scale
The severity of your pain can vary depending on a range of factors.
To decide on the most appropriate management strategy, use the below scale to assess the intensity of your pain on a scale from zero (0) to ten (10)?
‘0’ means ‘no pain’ and ‘10’ means ‘worst pain you can imagine’.
4. Interference scale
On a scale from zero (0) to ten (10), rate to what extent your pain is interfering with participation in your everyday activities.
‘0’ means ‘no interference’ and ‘10’ means ‘extreme interference’.
5. Action to take
This table provides a way to combine your severity and interference ratings from above scales to help you decide what level of support you may need to most effectively manage your problem.
Severity rating | Interference rating | Management strategies |
|---|---|---|
Mild (1-3) | Mild (1-3) | Self-manage without support |
Mild (1-3) | Moderate (4-6) | Self-manage without support |
Mild (1-3) | Severe (7-10) | Self-manage with support from your GP or other healthcare professional |
Moderate (4-6) | Mild (1-3) | Self-manage with support from your GP or other healthcare professional |
Moderate (4-6) | Moderate (4-6) | Self-manage with support from your GP or other healthcare professional |
Moderate (4-6) | Severe (7-10) | Self-manage with support from your GP or other healthcare professional |
Severe (7-10) | Mild (1-3) | Self-manage with support from your GP or other healthcare professional |
Severe (7-10) | Moderate (4-6) | Manage with specialist support |
Severe (7-10) | Severe (7-10) | Manage with specialist support |
Note: If you are self-managing without support and your problem has not been resolved, you should seek help from your GP, other healthcare professional or involve a spinal cord injury specialist in your management plan.
Prevent Problems
Prevention
How to prevent problems and control your pain
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Self-management tips
Seek timely treatment for medical problems
Exercise regularly
Get treatment for depression
Reduce stress
Distract yourself
Keep a pain diary
Get a wheelchair seating evaluation
Know your medications
Medical problems, such as urinary tract infections, constipation, poor sleep or spasms, can make pain worse and harder to treat.
Action: Be aware that early treatment for medical problems can help reduce pain.
Seek timely treatment for medical problems
Medical problems, such as urinary tract infections, constipation, poor sleep or spasms, can make pain worse and harder to treat.
Action: Be aware that early treatment for medical problems can help reduce pain.
Exercise regularly
Regular exercise can reduce pain as well as improve your mood and health. Physical activity and exercise are enjoyable and can distract you from pain.
Action: Seek advice from your healthcare professional to develop a suitable exercise program.
Get treatment for depression
Depression can make your pain worse and reduce your quality of life. It is best treated through counselling and medication.
Action: Seek help from your doctor and/or clinical psychologist. They can help you find ways to cope better with your chronic pain and improve your quality of life.
Reduce stress
Stress can make pain worse or make the pain harder for you to cope with. Learning techniques, such as relaxation training, biofeedback and hypnosis can decrease stress. Exercise also helps to reduce stress.
Action: Learn ways to manage stress through counselling and exercise.
Distract yourself
Distraction is one of the best methods for coping with chronic pain. When you are bored and inactive, you tend to focus more on your pain making your pain feel worse.
Action: Take part in enjoyable and meaningful activities to help you feel more in control of your life, especially when pain is at its worst.
Keep a pain diary
It is important to understand what makes you feel better and what makes pain worse. This will help you and your doctor find better ways to manage your pain.
Action: Keep a pain dairy to record how your pain interferes with your daily life.
[Image of actual pain diary to go here]
Get a wheelchair seating evaluation
Poor posture and improper seating can contribute to pain problems.
Action: Have your wheelchair and seating evaluated by a specialist therapist.
Know your medications
It is important to understand how your pain medications work as well as their side effects. Using alcohol like a pain medication can lead to serious problems.
Action: Discuss with your doctor what pain medications you are taking and their possible harmful effects.
Take home messages
Work with your
HEALTH CARE TEAM
to improve your pain
Develop a pain
MANAGEMENT PLAN
that gets results
Light
EXERCISE
is recommended most days
Be aware of all possible
SIDE EFFECTS
of medications
MEDITATE
to train the brain to reduce pain