Relationship between neuropathic pain and spasticity in patients with spinal cord injury: cross-sectional clinical study

Sousa, Caio Vinicius Monteiro de; Silva, Wladimir Gama da; Machado, Fabiane Nunes; Santos, Ana Paula

doi:10.63231/2595-0118.20250010-pt

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ORIGINAL ARTICLE • Brazilian Journal of Pain 8 • 2025 • https://doi.org/10.63231/2595-0118.20250010-en linkcopy

Relationship between neuropathic pain and spasticity in patients with spinal cord injury: cross-sectional clinical study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES Neuropathic pain and spasticity are common complications in patients with spinal cord injury (SCI). Although they share several characteristics, the literature has insufficient evidence to support their correlation in SCI patients. This study aimed to characterize neuropathic pain in SCI patients and investigate its correlation with spasticity.

METHODS A cross-sectional study was conducted with 20 SCI patients treated at a rehabilitation center in Belo Horizonte, Brazil. Clinical and demographic data were collected, along with a semi-structured questionnaire to characterize pain. Pain intensity was assessed using the Numerical Rating Scale (NRS), while the frequency and severity of spasms were evaluated using the Penn Spasm Frequency Scale. Statistical analyses included the Kolmogorov-Smirnov test, Spearman correlation, and Chi-square test (p ≤ 0.05).

RESULTS Of the patients, 90% were male, and 79% had paraplegia. Neuropathic pain was reported in 50% of cases, with an average score of 7.2 ± 2.2. The pain primarily affected the lumbar region and was described as burning by most patients (70%). Spasms were reported by 85%, with 55% experiencing moderate to severe spasms frequently. No significant correlation was found between pain intensity and spasm frequency (r = 0.191; p = 0.43) or severity (r = -0.239; p = 0.32). Additionally, no association was observed between the presence of pain and the occurrence of spasms (p = 0.86).

CONCLUSION Neuropathic pain and spasticity are common issues following SCI. However, this study did not identify a significant correlation between these conditions.

Keywords:
Pain; Chronic pain; Muscle Spasticity; Spinal cord injuries

HIGHLIGHTS

Neuropathic pain was frequent in patients with spinal cord trauma, mostly intense and localized in the lumbar region

Spasticity was common, often accompanied by moderate to severe spasms

No significant relationship between pain intensity and spasms were observed

Variables	n (%)
Age (years)*
18-29	7 (36.8%)
30-39	9 (47.4%)
40-49	3 (15.8%)
Schooling
Elementary incomplete	1 (5%)
Elementary complete	3 (15%)
High school incomplete	3 (15%)
High school complete	8 (40%)
College incomplete	3 (15%)
College complete	2 (10%)
Work
Yes	10 (50%)
No	10 (50%)
Neurological level*
C4	1 (5.1%)
C6	2 (11%)
C8	1 (5.1%)
T4	1 (5.1%)
T5	1 (5.1%)
T6	4 (21.1%)
T7	1 (5.1%)
T8	3 (16.1%)
T9	3 (16.1%)
T11	1 (5.1%)
T12	1 (5.1%)
(AIS)*
A	15 (79%)
B	3 (16%)
C	0 (0%)
D	1 (5%)
Comorbidities
Yes (SAH)	2 (10%)
No	18 (90%)

Numerical Rating Scale	n (%)	Classification of pain
0	10 (50%)	No pain
1 to 4	2 (10%)	Mild pain
5 to 6	1 (5%)	Moderate pain
7 to 10	7 (35%)	Severe pain

Areas of pain	n (%)
Low back	4 (40%)
Thoracic	2 (20%)
Gluteal	1 (10%)
Thoracolumbar	1 (10%)
LL and thoracic	1 (10%)
LL and lower back	1 (10%)
Pain description
Burning	7 (70%)
Stabbing	3 (30%)

PENN Scale	n (%)
Frequency of spasms
0 - Absence of spasms	3 (15%)
1 - Mild spasms induced by stimulation	4 (20%)
2 - Complete spasms, not frequent, and occurring less than once an hour	2 (10%)
3 - Spasms occurring more than once per hour	7 (35%)
4 - Spasms occurring more than 10 times per hour	4 (20%)
Severity of spasms
1 - Mild	6 (30%)
2 - Moderate	7 (35%)
3 - Severe	4 (20%)

Scores	PENN Scale	R	p-value
NRS	Frequency of spasms	0.191	0.43
NRS	Severity of spasms	-0.239	0.32

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Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
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Data missing from one medical record; AIS: American Spine Injury Association; AIS A: Complete Spinal Cord Injury; AIS B: Incomplete, sensitivity present and motor absent; AIS C: Incomplete, sensibility present, and motor less than half of the key muscles below the neurological level have a muscular strength level ≥ 3. AIS D: Incomplete, sensibility present and motor at least half of the key muscles below the neurological level show muscle strength grade ≥ 3; SAH: systemic arterial hypertension.