ORIGINAL RESEARCH| Volume 103, ISSUE 4, P729-737, April 2022

Prevalence and Impact of Neuropathic and Nonneuropathic Pain in Chronic Spinal Cord Injury

Published:August 02, 2021DOI:



      To compare prevalence, intensity ratings, and interference ratings of neuropathic pain (NeuP) and nociceptive pain in people with chronic spinal cord injury (SCI)


      Cross-sectional survey.


      Six SCI Model System centers in the United States.


      Convenience sample of 391 individuals (N=391) with traumatic SCI, 18 years or older, 81% male, 57% White.


      Not applicable.

      Main Outcome Measures

      Survey based on the International Spinal Cord Injury Pain Basic Data Set and the Spinal Cord Injury Pain Instrument, including 0-10 numeric ratings of pain intensity and pain interference with daily activities, mood, and sleep


      A total of 80% of those surveyed reported having at least 1 pain problem; 58% reported 2 or more pain problems; 56% had probable NeuP; and 49% had non-NeuP. When comparing ratings for all pains (n=354 for NeuP, n=290 for non-NeuP) across participants, probable NeuPs were significantly more intense (6.9 vs 5.7) and interfered more with activities (5.2 vs 3.7), mood (4.9 vs 3.2), and sleep (5.4 vs 3.6) than non-NeuPs (all P<.001). However, when comparing ratings for probable NeuPs and non-NeuPs within participants, for the subgroup of 94 participants with both pain types, only ratings for sleep interference were found to be significantly different between the pain types. Additionally, we found significantly greater prevalence of NeuP and non-NeuP for women compared with men and of NeuP for those with paraplegia compared with those with tetraplegia.


      Independent assessment of the pain conditions experienced by an individual with SCI is useful in understanding the differential effect that pain type has on quality of life. This is particularly important regarding sleep interference and should be kept in mind when determining treatment strategies for meeting patient-centered outcome goals.


      List of abbreviations:

      ISCIPBDS (International Spinal Cord Injury Pain Basic Data Set), NeuP (neuropathic pain), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model Systems), SCIPI (Spinal Cord Injury Pain Instrument)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cardenas DD
        • Turner JA
        • Warms CA
        • Marshall HM.
        Classification of chronic pain associated with spinal cord injuries.
        Arch Phys Med Rehabil. 2002; 83: 1708-1714
        • Felix ER
        • Cruz-Almeida Y
        • Widerström-Noga EG.
        Chronic pain after spinal cord injury: what characteristics make some pains more disturbing than others?.
        J Rehabil Res Dev. 2007; 44: 703-715
        • Rodrigues D
        • Tran Y
        • Wijesuriya N
        • Guest R
        • Middleton J
        • Craig A.
        Pain intensity and its association with negative mood States in patients with spinal cord injury.
        Pain Ther. 2013; 2: 113-119
        • Min JA
        • Lee CU
        • Hwang SI
        • et al.
        The moderation of resilience on the negative effect of pain on depression and post-traumatic growth in individuals with spinal cord injury.
        Disabil Rehabil. 2014; 36: 1196-1202
        • Kim S
        • Whibley D
        • Williams DA
        • Kratz AL.
        Pain acceptance in people with chronic pain and spinal cord injury: daily fluctuation and impacts on physical and psychosocial functioning.
        J Pain. 2020; 21: 455-466
        • Krauss J.
        Self-reported problems after spinal cord injury: implications for rehabilitation practice.
        Top Spinal Cord Inj Rehabil. 2007; 12: 35-44
      1. North American Spinal Cord Injury Consortium. Needs of the community living with SCI in North America. Available at: Accessed August 29, 2021.

        • Bryce TN
        • Biering-Sorensen F
        • Finnerup NB
        • et al.
        International spinal cord injury pain classification: part I. Background and description.
        Spinal Cord. 2012; 50 (March 6-7, 2009): 413-417
        • Finnerup NB
        • Norrbrink C
        • Trok K
        • et al.
        Phenotypes and predictors of pain following traumatic spinal cord injury: a prospective study.
        J Pain. 2014; 15: 40-48
        • Burke D
        • Fullen BM
        • Stokes D
        • Lennon O.
        Neuropathic pain prevalence following spinal cord injury: a systematic review and meta-analysis.
        Eur J Pain. 2017; 21: 29-44
        • Widerström-Noga E
        • Biering-Sorensen F
        • Bryce TN
        • et al.
        The International Spinal Cord Injury Pain Basic Data Set (version 2.0).
        Spinal Cord. 2014; 52: 282-286
        • Finnerup NB
        • Baastrup C.
        Spinal cord injury pain: mechanisms and management.
        Curr Pain Headache Rep. 2012; 16: 207-216
        • Warms CA
        • Turner JA
        • Marshall HM
        • Cardenas DD.
        Treatments for chronic pain associated with spinal cord injuries: many are tried, few are helpful.
        Clin J Pain. 2002; 18: 154-163
        • Felix ER.
        Chronic neuropathic pain in SCI: evaluation and treatment.
        Phys Med Rehabil Clin N Am. 2014; 25: 545-571
        • Gilron I
        • Bailey JM
        • Vandenkerkhof EG.
        Chronobiological characteristics of neuropathic pain: clinical predictors of diurnal pain rhythmicity.
        Clin J Pain. 2013; 29: 755-759
        • Celik EC
        • Erhan B
        • Lakse E.
        The clinical characteristics of neuropathic pain in patients with spinal cord injury.
        Spinal Cord. 2012; 50: 585-589
        • Bouhassira D
        • Lanteri-Minet M
        • Attal N
        • Laurent B
        • Touboul C.
        Prevalence of chronic pain with neuropathic characteristics in the general population.
        Pain. 2008; 136: 380-387
        • Dijkers M
        • Bryce T
        • Zanca J.
        Prevalence of chronic pain after traumatic spinal cord injury: a systematic review.
        J Rehabil Res Dev. 2009; 46: 13-29
        • Werhagen L
        • Budh CN
        • Hultling C
        • Molander C.
        Neuropathic pain after traumatic spinal cord injury–relations to gender, spinal level, completeness, and age at the time of injury.
        Spinal Cord. 2004; 42: 665-673
        • Burke D
        • Fullen BM
        • Lennon O.
        Pain profiles in a community dwelling population following spinal cord injury: a national survey.
        J Spinal Cord Med. 2019; 42: 201-211
        • Cardenas DD
        • Bryce TN
        • Shem K
        • Richards JS
        • Elhefni H.
        Gender and minority differences in the pain experience of people with spinal cord injury.
        Arch Phys Med Rehabil. 2004; 85: 1774-1781
        • Hardt J
        • Jacobsen C
        • Goldberg J
        • Nickel R
        • Buchwald D.
        Prevalence of chronic pain in a representative sample in the United States.
        Pain Med. 2008; 9: 803-812
        • Torrance N
        • Smith BH
        • Bennett MI
        • Lee AJ.
        The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey.
        J Pain. 2006; 7: 281-289
        • Nahin RL.
        Estimates of pain prevalence and severity in adults: United States, 2012.
        J Pain. 2015; 16: 769-780
        • Bryce TN
        • Richards JS
        • Bombardier CH
        • et al.
        Screening for neuropathic pain after spinal cord injury with the spinal cord injury pain instrument (SCIPI): a preliminary validation study.
        Spinal Cord. 2014; 52: 407-412
        • Widerström-Noga E
        • Biering-Sorensen F
        • Bryce TN
        • et al.
        The International Spinal Cord Injury Pain Extended Data Set (version 1.0).
        Spinal Cord. 2016; 54: 1036-1046
        • Widerström-Noga E
        • Biering-Sorensen F
        • Bryce T
        • et al.
        The International Spinal Cord Injury Pain Basic Data Set.
        Spinal Cord. 2008; 46: 818-823
        • Jensen MP
        • Widerström-Noga E
        • Richards JS
        • Finnerup NB
        • Biering-Sorensen F
        • Cardenas DD.
        Reliability and validity of the International Spinal Cord Injury Basic Pain Data Set items as self-report measures.
        Spinal Cord. 2010; 48: 230-238
      2. Widerström-Noga E, Biering-Sorensen F, Bryce T, et al. Syllabus (instructions) - version 2.0. Available at: Accessed March 23, 2021, 2021.

        • George D
        • Mallery P.
        SPSS for Windows step by step - a simple guide and reference 16.0 update.
        9th ed. Pearson Education Inc, Boston2009
        • Stoelb BL
        • Carter GT
        • Abresch RT
        • Purekal S
        • McDonald CM
        • Jensen MP.
        Pain in persons with postpolio syndrome: frequency, intensity, and impact.
        Arch Phys Med Rehabil. 2008; 89: 1933-1940
        • Rethorn ZD
        • Pettitt RW
        • Dykstra E
        • Pettitt CD.
        Health and wellness coaching positively impacts individuals with chronic pain and pain-related interference.
        PLoS One. 2020; 15e0236734
        • Peacock S
        • Patel S.
        Cultural influences on pain.
        Rev Pain. 2008; 1: 6-9
        • Campbell CM
        • Edwards RR.
        Ethnic differences in pain and pain management.
        Pain Manag. 2012; 2: 219-230
        • Algom D
        • Marks LE.
        Individual differences in loudness processing and loudness scales.
        J Exp Psychol Gen. 1984; 113: 571-593
        • Turner JA
        • Franklin G
        • Heagerty PJ
        • et al.
        The association between pain and disability.
        Pain. 2004; 112: 307-314
        • Alschuler KN
        • Jensen MP
        • Ehde DM.
        Defining mild, moderate, and severe pain in persons with multiple sclerosis.
        Pain Med. 2012; 13: 1358-1365
        • Jensen MP
        • Smith DG
        • Ehde DM
        • Robinsin LR.
        Pain site and the effects of amputation pain: further clarification of the meaning of mild, moderate, and severe pain.
        Pain. 2001; 91: 317-322
        • Widerström-Noga EG
        • Felipe-Cuervo E
        • Broton JG
        • Duncan RC
        • Yezierski RP
        Perceived difficulty in dealing with consequences of spinal cord injury.
        Arch Phys Med Rehabil. 1999; 80: 580-586
        • Siddall PJ
        • McClelland JM
        • Rutkowski SB
        • Cousins MJ.
        A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury.
        Pain. 2003; 103: 249-257
        • Bouhassira D
        • Attal N
        • Alchaar H
        • et al.
        Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).
        Pain. 2005; 114: 29-36
        • Burke D
        • Lennon O
        • Blake C
        • et al.
        An internet-delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: a randomized controlled trial.
        Eur J Pain. 2019; 23: 1264-1282
        • Rabbitts JA
        • Holley AL
        • Karlson CW
        • Palermo TM.
        Bidirectional associations between pain and physical activity in adolescents.
        Clin J Pain. 2014; 30: 251-258
        • Lavigne G
        • Khoury S
        • Chauny JM
        • Desautels A.
        Pain and sleep in post-concussion/mild traumatic brain injury.
        Pain. 2015; 156: S75-S85
        • Dworkin RH
        • Turk DC
        • Wyrwich KW
        • et al.
        Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations.
        J Pain. 2008; 9: 105-121
        • Afolalu EF
        • Ramlee F
        • Tang NKY.
        Effects of sleep changes on pain-related health outcomes in the general population: a systematic review of longitudinal studies with exploratory meta-analysis.
        Sleep Med Rev. 2018; 39: 82-97
        • Finan PH
        • Goodin BR
        • Smith MT.
        The association of sleep and pain: an update and a path forward.
        J Pain. 2013; 14: 1539-1552
        • Umeda M
        • Kim Y.
        Gender differences in the prevalence of chronic pain and leisure time physical activity among US adults: a NHANES study.
        Int J Environ Res Public Health. 2019; 16: 988
        • Muller R
        • Brinkhof MW
        • Arnet U
        • et al.
        Prevalence and associated factors of pain in the Swiss spinal cord injury population.
        Spinal Cord. 2017; 55: 346-354
        • Mills SEE
        • Nicolson KP
        • Smith BH.
        Chronic pain: a review of its epidemiology and associated factors in population-based studies.
        Br J Anaesth. 2019; 123: e273-e283
        • Franz S
        • Schuld C
        • Wilder-Smith EP
        • et al.
        Spinal Cord Injury Pain Instrument and painDETECT questionnaire: convergent construct validity in individuals with spinal cord injury.
        Eur J Pain. 2017; 21: 1642-1656
        • Wichniak A
        • Wierzbicka A
        • Walecka M
        • Jernajczyk W.
        Effects of antidepressants on sleep.
        Curr Psychiatry Rep. 2017; 19: 63