Pain following SCI is quite common. The most common type of pain post SCI is central or neuropathic in nature characterized by a dysesthetic, burning pain below the level of SCI. Borderzone or segmental pain is much less common; occurring along the border between normal and absent sensation. The precise etiology of central/neuropathic or borderzone segmental pain is not known. There is some evidence suggesting an association may exist between the central or neuropathic dysesthetic burning pain and abnormalities of the sympathetic nervous system. Musculoskeletal pain, either secondary to the original trauma or to overuse is both common and well understood. Unfortunately, the management of central or neuropathic pain remains difficult and largely ineffective.

• For many SCI patients pain has a significant impact on quality of life.
• Over 50% of SCI patients develop chronic pain.  Severe pain is more common the lower down the lesion in the spinal cord. Pain post-SCI most often begins within the first 6-12 months post-SCI. 
• The most common types of pain post SCI are: 1) is a burning pain (likely neuropathic) usually localized to the front of torso, buttock or legs; 2) an aching pain (likely musculoskeletal) usually localized to the neck, shoulders and back.
• There is limited level 4 evidence that massage and heat are the best non-pharmacological treatments for pain post SCI.
• There is level 1 evidence that in general acupuncture is no more effective than Trager therapy or sham acupuncture in reducing nociceptive musculoskeletal shoulder pain post SCI.
• There is level 4 evidence that acupuncture and electroacupuncture reduces neuropathic pain of patients with SCI.
• There is level 1 evidence that a regular exercise program significantly reduces post-SCI pain.
• There is level 2 evidence (from one RCT and one PCT) that a shoulder exercise protocol reduces the intensity of shoulder pain post SCI.
• There is level 4 evidence that the MAGIC wheels 2-gear wheelchair results in less shoulder pain.
• There is level 4 evidence that hypnosis reduces pain intensity post SCI.
• There is level 2 evidence that a cognitive behavioural pain management program with pharmacological treatment improves chronic pain post SCI over the short term.
• There is level 2 evidence that cognitive-behavioural therapy alone does not change post-SCI pain intensity.
• There is limited (Level 4) evidence, based on one pre-post study with small numbers, that visual imagery may reduce neuropathic pain post SCI.
• Based on three level 1 studies, there is strong evidence, of the benefits of transcranial electrical stimulation in reducing post-SCI pain.
• There is limited (Level 4) evidence that using a static field magnet helps to reduce reports of sharp, stabbing nociceptive shoulder pain but does not significantly reduce the VAS score of pain in individuals with a SCI.
• There is limited (level 4) evidence that TENS reduced at-the-injury site pain in only a minority of patients with thoracic or cauda equina SCI, but not those with cervical SCI.
• There is level 1 evidence that transcranial magnetic stimulation significantly reduced post-SCI pain significantly over the long-term.
• There is level 1 evidence that Gabapentin and pregabalin improve neuropathic pain post SCI. 
• There is level 4 evidence that the anticonvulsant Gabapentin is more effective when SCI pain is <6 mos than >6 mos.
• There is level 2 evidence that lamotrigine improves neuropathic pain in patients with incomplete SCI.
• Based on one Level 1 study, Levetiracetam is not effective in reducing neuropathic pain post SCI.
• There is Level 1 evidence that valproic acid does not significantly relieve neuropathic pain post SCI.
• There is level 1 evidence that amitriptyline is effective in the treatment of post-SCI pain in depressed individuals.
• There is Level 1 evidence that trazodone does not reduce post-SCI neuropathic  pain.
• There is level 1 evidence (based on one RCT) that Lidocaine delivered through a subarachnoid lumbar catheter provides short-term relief of pain greater than placebo.
• There is level 1 evidence (based on one RCT) that intravenous Ketamine significantly reduces allodynia when compared to placebo.
• There is level 1 evidence (based on one RCT) that mexilitene (a derivative of lidocaine) does not improve SCI dysesthetic pain when compared to placebo.
• There is level 1 evidence (based on one RCT) that Intrathecal Baclofen reduces dysesthetic pain post SCI.  However, the sample size was small and a before and after trial reported contradictory results.
• There is level 4 evidence that Intrathecal Baclofen reduces musculoskeletal pain post-SCI by reducing spasticity.
• There is level 4 evidence that motor point phenol block is effective in reducing short term spastic shoulder pain post SCI.
• There is level 4 evidence that local botulinum toxin injections to treat focal spasticity reduces pain.
• There is level 1 evidence that intravenous morphine significantly reduces mechanical allodynia more than placebo.
• There is level 1 evidence that tramadol is effective in reducing neuropathic pain post SCI.
• There is level 1 evidence that alfentanil reduces overall post SCI pain.
• There is level 1 evidence that alfentanil is more effective at reducing wind up like pain than ketamine.
• There is conflicting evidence for the use of THC in reducing spastic pain in SCI individuals.
• There is level 1 evidence (based on only one RCT) that Intrathecal Clonidine alone did not provide pain relief greater than placebo, although there was a trend.
• There is level 2 evidence (based on only one prospective controlled study) that the combination of Intrathecal Morphine and Clonidine did provide pain relief greater than placebo.
• There is level 4 evidence that topical capsaicin reduces post-SCI radicular pain.
• There is level 4 evidence that spinal cord stimulation improves post-SCI pain.
• There is level evidence to support the use of dorsal longitudinal T-myelotomy procedures, in particular Pourpre’s technique, to reduce spastic pain post SCI.
• There is limited (Level 4) evidence to support the use of the DREZ surgical procedure to reduce pain post SCI. It may be that some populations (segmental pain) are more likely to benefit from this procedure.