What is it?
Neuropathic pain is pain that comes from injured nerves themselves, not from injured muscles, joints, or skin. After SCI, about half of patients have it. It can be at the level of injury, below the level, or both.
Common descriptions:
- Burning
- Pins and needles
- Electric shocks
- Squeezing or banding
- Stabbing
- Strange temperatures (cold pain in a warm room)
What triggers it
- Cold weather.
- Stress, anxiety, poor sleep.
- A full bladder or bowel — sometimes the first sign of a UTI.
- Skin breakdown.
- Spasticity flares.
- Sometimes nothing at all — that is the nature of nerve pain.
What you can do without medicine
- Sleep hygiene. Poor sleep makes nerve pain worse the next day. Same time to bed, dark room, screens off, caffeine before noon.
- TENS (transcutaneous electrical nerve stimulation) — pads on the skin send mild current. Some patients get good relief.
- Heat and cold packs. Try both — different things work for different people.
- Distraction and pacing. Pain that takes up your full attention worsens. Music, conversation, work.
- Mindfulness and CBT. Research shows these reduce the impact of chronic pain even when the pain itself does not change much. Apps and pain psychologists both help.
- Exercise. Counterintuitive but real. Aerobic exercise above the level reduces overall pain ratings.
💊 First-line medicines
- Gabapentin — start 100–300 mg at bedtime, titrate to 600–1200 mg three times daily over weeks. Watch for sleepiness, dizziness, weight gain.
- Pregabalin (Lyrica) — 75 mg twice daily, can go to 300 mg twice daily. Faster onset; controlled substance in the US.
💊 Second-line medicines
- Tricyclic antidepressants — amitriptyline or nortriptyline 10–25 mg at bedtime. Helps sleep too. Watch for dry mouth, urinary retention.
- SNRIs — duloxetine 30–60 mg daily.
- Topical lidocaine 5% patch — for one localized spot.
- Topical capsaicin 8% patch (medical office only).
⚠️ Things that usually do not work
- Opioids. Modest short-term benefit, big long-term cost (tolerance, constipation, falls). Most pain experts avoid them as primary therapy for SCI nerve pain.
- Benzodiazepines. Short-term relief, long-term harm.
- Cannabis. Mixed evidence; legal status varies. Not a primary option.
📞 Call your doctor if
- Pain is suddenly much worse.
- New pain in a place that was numb.
- Pain comes with a fever, change in spasticity, or a new skin breakdown — these often mean a hidden infection or pressure injury.
- You cannot sleep at all because of pain.
At your next clinic visit
Bring a 2-week pain diary: morning, noon, evening rating (0–10), what you did, what helped. The pattern guides medicine choice more than the average.
Education only. Not medical advice. If you have a clinical question, talk to your rehab team. For emergencies call 911.