What medications are used for pain after SCI?

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

Medications are often the first treatments for managing pain after SCI. Speak with your health providers for detailed information about any medication you are considering taking.

Medications are one of the many ways pain can be managed after SCI.⁷

Except for spasticity (muscle spasms below the level of SCI), most musculoskeletal pain after SCI is treated with common medications such as over-the-counter pain relievers. Because of this, the research evidence supporting the use of these medications is often based on research done in people without SCI and on expert opinion.

Acetaminophen (Paracetamol) works to reduce pain and fever through mechanisms in the nervous system that are not well understood. Acetaminophen is usually taken by mouth and is a common first treatment for musculoskeletal pain after SCI.

Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, naproxen, and diclofenac reduce pain and inflammation by affecting chemicals in the inflammatory response. NSAIDs may be taken by mouth, or in some cases, applied to the skin over small areas. NSAIDs can sometimes worsen stomach problems, so they are used as a second-line treatment after SCI.

Corticosteroids mimic the effects of the hormone cortisol to reduce inflammation. Corticosteroids are injected into painful joints to relieve pain caused by inflammation, on an as-needed basis.

Antispasticity medications such as Baclofen and Botulinum toxin (Botox) may be used to help relax painful muscle spasms caused by spasticity. Medications like Baclofen are usually taken by mouth. Medications can also be injected into the affected muscles (in the case of Botox) or into the spinal canal (in the case of Baclofen, via a pump that is surgically implanted).

Opioid medications are a type of narcotic pain medication that binds to opioid receptors in the body, reducing pain messages sent to the brain. Opioids may be used for muscle, joint, and bone pain and sometimes for neuropathic pain after SCI. However, opioids can worsen constipation, induce sleep disordered breathing, and may be linked to dependence when used long-term. Therefore, although they are effective for managing pain in the short term, the goal is usually to get off opioids once the acute pain is controlled and avoid their use for chronic pain management.

See what Matt has to say about his initial thoughts about medications following an SCI.

Matt describes his experience with the withdrawal effects of stopping medication.

Neuropathic pain is treated with different types of medications than musculoskeletal pain. The strongest evidence supports using the anticonvulsants Gabapentin and Pregabalin and the antidepressants Amitriptyline, Nortriptyline, and Desipramine (all the same class of drug) for treating neuropathic pain after SCI. There are also many other medications that need further study for pain after SCI.

Anticonvulsants, originally used for epileptic seizures, are thought to reduce neuropathic pain by calming hyperactive nerve cells in the spinal cord.

Normally used to treat depression, certain types of antidepressants, for example, a class of drugs called tricyclic antidepressants such as Amitriptyline, are also used for neuropathic pain. Antidepressants increase the availability of the chemicals norepinephrine and serotonin in the body that may help to control pain signals in the spinal cord.

Anesthetic medications like Lidocaine and Ketamine provide short-term pain relief by blocking the transmission of nerve signals involved in sensation and pain. These may be applied directly to the skin or given by injection, catheter, or intravenous line.

Clonidine is a drug that is normally used for lowering blood pressure. Clonidine may also stimulate parts of the spinal cord that decrease pain signals.

Capsaicin is a chemical compound found in hot peppers that may reduce pain. Capsaicin reduces the action of a molecule called substance P that transmits pain signals in the body. Capsaicin is applied to the skin to reduce pain in small areas.

Cannabinoid medications like Nabilone contain chemicals called cannabinoids that are present in cannabis (marijuana). Cannabinoids also occur naturally in the body and play a role in reducing pain signals in the nervous system. Cannabinoid medications may be taken by mouth or inhaled.