Spinal Cord Injury Pain Quick Steps
Does the patient have
Paraplegia (normal movement and feeling in the upper limbs, but absent or abnormal in lower limbs and trunk) or
Tetraplegia (absent or abnormal movement or feeling in the upper and lower limbs and trunk)?
What level is the spinal cord injury?
(e.g. L4)
Is the injury
Complete (unable to move and feel any part of the body below the level of injury) or
Incomplete (able to move and/or feel some parts of the body below the level of injury)?
Please specify details of the pain in the grid below. If the pain is another type of pain not listed on the grid or is unknown, please indicate in the text box below the grid.
Neuropathic pain |
Musculoskeletal pain |
Visceral pain |
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Pain features |
Burning, electric shock-like, pricking, pins and needles, sharp, shooting, hot-burning, tingling, squeezing, cold, electric, or shooting pain |
Aching, sharp, dull, posture or movement related |
Dull, cramping, tender |
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Above the level of injury |
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At the level of injury |
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Below the level of injury |
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Other type of pain or unknown (e.g. irritable bowel syndrome, complex regional pain syndrome)
What is the average intensity of pain on a scale of 0 - 10 / 10?
where 0 = no pain and 10 = pain as bad as you can imagine
The following are red flag conditions
New pain with recent change in sensory or motor function
Generalised systemic symptoms
Autonomic dysreflexia
Change in bladder function
Change in bowel function
Pressure injury
Recent fall or trauma
Indicators of risk or misuse may include:
Dose > 40mg morphine equivalent per day (Opioid Calculator Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists)
Treatment duration > 90 days
Opioid risk tool > 3 (Pain Management Network Opioid Risk Assessment Tool)
Side effects from OTC and other medications evident
Social impact of drug and alcohol misuse (AUDIT (Alcohol Use Disorders Identification Test) Saunders JB)
On average, how much has pain interfered with your day to day activities in the last week?
Rate yourself between 0 and 10, where 0 = no interference and 10 = extreme interference
How much has pain interfered with your mood in the last week?
Rate yourself between 0 and 10, where 0 = no interference and 10 = extreme interference
How much has pain interfered with your sleep in the last week?
Rate yourself between 0 and 10, where 0 = no interference and 10 = extreme interference
Consider if the person is
Maintaining normal activities despite pain (at home or work)
Using non-drug ways of self-calming (e.g. relaxation, meditation, gentle exercise)
Taking a problem-solving approach to managing their pain (not expecting doctor to sort it out alone)
Minimising alarmist thinking
Minimising avoidant behaviours
Is the patient actively engaged in self management?
Do you have any additional notes to add to the Pain Management Plan?
When to consider referral to or phone consultation with a pain specialist
or clinic
- Declining physical function
- Presence of complicating or persisting red flags
- Co morbid yellow flags or increasing psychological distress: K10 > 19, Orebro > 50, BPI interference
score > 50
- Excessive health care use and or multiple medications for pain
- Difficulty weaning chronic opioid therapy
- Significant opioid risk:
- opioid morphine equivalent dose > 40mg moderate risk of harm
- opioid morphine equivalent dose > 100mg high risk of harm
- opioid use > 90 days
Tertiary referral and advice
- opioid morphine equivalent dose > 40mg moderate risk of harm
- opioid morphine equivalent dose > 100mg high risk of harm
- opioid use > 90 days
For complex pain presentations or pain which is not responding to primary care level treatment, consider referral to tertiary pain and/or spinal services.
