Chronic pain after spinal cord injury: an expedient diagnostic approach.

The reliability of distinguishing central, musculoskeletal, and syringomyelic pain by two points of history: (1) pain quality and (2) pain location relative to the level of paralysis in spinal cord injury patients was tested by (1) physical examination, and (2) by radiographic imaging. Fifty five incidents of chronic pain (median duration 10 years, range 3 weeks-42 years) were found in a survey of 66 spinal cord injured patients. Central pain was suggested in 24 patients on the basis of a predominant 'neurogenic' pain quality: burning, stabbing, needles and pins, or numbness; and a location at or distal to the level of paralysis. Neurogenic pain was not associated with structural pathology in these patients. Musculoskeletal pain was suggested in 20 instances on the basis of predominantly aching pain and a location at or distal to the level of paralysis. Aching pain was associated with degenerative joint disease (11 each); scoliosis, shoulder dislocation, contractures (2 each); fracture, soft tissue calcium deposit (1 each) in 19 patients. Syringomyelic pain was suggested in 11 instances solely on the basis of pain location above the level of paralysis. Magnetic resonance imaging revealed extensive syringomyelia in 8 patients. It is proposed that the quality and location of chronic pain can quickly suggest confirmatory examinations, sometimes revealing correctable causes.