What physical treatments are used for pain after SCI?

Author: SCIRE Community Team | Reviewer: Patricia Mills | Published: 12 April 2017 | Updated: 18 October 2017, 10 October 2024

Physical treatments like exercise, massage, and electrotherapy may be used as part of physical or occupational therapy sessions or at home. Research evidence suggests that regular exercise, shoulder exercise, acupuncture, and TENS may help reduce some types of pain after SCI. However, many of the other physical treatments have not been studied extensively among people with SCI and we do not know for sure how effective they are.

Regular exercise, such as aerobic exercise, strength training, and exercise programs, can help a person stay healthy, reduce stress, and improve mood, which can help to treat pain.

Read our content on Movement and Exercise for more information!

Exercise provides various health benefits including pain reduction.¹⁰

Exercise is often used to treat pain from shoulder injuries. Shoulder exercise focuses on strengthening, stretching, and improving movement of the shoulder joint.

Read our article on Shoulder Injury and Pain for more information!

Massage is commonly used to help manage muscle pain.

Hands-on techniques that involve mobilizing the soft tissues and joints to restore movement and reduce pain may be used for musculoskeletal pain. Manipulation techniques (‘thrust’ techniques) are not usually done after SCI because they can increase the risk of broken bones.

Heat is a common treatment for pain in the muscles and joints. Heat may reduce pain by stimulating sensory pathways that dampen pain signals. Heat should be used cautiously (or not used at all) in areas of reduced sensation or sensitive skin to avoid burns.

Thin needles are inserted in specific acupuncture points to treat pain.¹¹

Acupuncture is an alternative practice derived from traditional Chinese medicine that involves the insertion of needles into specific points on the body. Acupuncture may help to stimulate the release of chemicals in the nervous system that reduce pain.

Dry needling (sometimes called intramuscular stimulation) is a technique for releasing muscle tension by stimulating sensitive points with an acupuncture needle.

Read our article on Acupuncture for more information!

Transcutaneous electrical nerve stimulation (TENS) is the most common form of electrotherapy used in rehabilitation settings. TENS delivers electrical stimulation through electrodes placed on an area where pain is felt. The electrical stimulation may help to block pain signals in the spinal cord.

Read our article on TENS for more information!

Epidural stimulation or spinal cord stimulation involves the surgical placement of electrodes on the spinal cord. While the mechanism is unclear, it is thought that the electric currents produced by the electrodes stimulate areas of the spinal cord to interrupt the pain signals being sent to the brain. Weak evidence suggests that only some individuals receive pain reduction, with the greatest reduction seen in individuals with an incomplete SCI.

A study reported that satisfaction for epidural stimulation in pain reduction significantly drops off over time, with only 18% of participants being satisfied after 3 years. The research for epidural stimulation in pain reduction is still limited, with relatively few studies specifically focused on individuals with SCI.

Read our article on Epidural Stimulation for more information!

Transcranial electrical stimulation and transcranial magnetic stimulation are treatment options that have been researched extensively but are not regularly available at this time. These treatments are both supported by strong evidence to be effective for treating neuropathic pain after SCI.

TMS is a non-invasive technique that may be used to treat neuropathic pain.¹²

Transcranial electrical stimulation involves electrodes placed on the scalp to deliver electrical stimulation to areas of the brain that may help to reduce pain.

Transcranial magnetic stimulation (TMS) involves the use of an electromagnetic coil placed over the head to produce magnetic pulses that stimulate areas of the brain to reduce pain.