A proposed algorithm for the management of pain following spinal cord injury

Study design: Review. Objectives: To review published articles on the assessment, diagnosis and treatment of pain following spinal cord injury ( SCI) and to synthesise evidence from these materials to formulate and propose a systematic approach to management. Methods: Relevant articles regarding the treatment of pain were identified from electronic databases using the search terms (('spinal cord injury' or 'spinal cord injuries') and 'pain') and both ('treatment') and ('randomised controlled trials'). Relevant articles were also identified through citations in indexed journal publications and book chapters on this topic. Results: Review of the literature indicates that there are a large variety of treatments used in the management of pain following SCI with a small number supported by strong evidence for effectiveness. A treatment algorithm is proposed based on identification of underlying pain contributors and application of appropriate treatment. Conclusion: Although there are relatively few studies clearly indicating efficacy in this population, an algorithm for the management of pain following SCI might assist to maximise our effectiveness in the treatment of this condition. It is recognised that choice of treatment is also determined by factors such as medication availability, cost and side effects as well as the preferences and characteristics of the person being treated. Nevertheless, an algorithm is proposed as a way to synthesise our current level of knowledge, identify gaps for further study and aid in the management of this difficult problem.