- Spinal cord injury (SCI) affects more than 20 million people worldwide and pain is the most prevalent secondary condition, with substantial psychosocial consequences.
- Researchers from NeuRA and UNSW Sydney have found higher pain intensity was consistently associated with poorer psychological and social wellbeing.
- The findings indicate a need to take a more holistic approach to pain management for people with SCI, including psychological and social support.
Spinal Cord Injury (SCI) leaves many people with ongoing pain and significant psychosocial impacts, with researchers confirming the link and calling for integrated treatment approaches.
Research from Neuroscience Research Australia (NeuRA) and the University of NSW Sydney (UNSW) examined the associations between pain intensity and psychosocial outcomes in adults with chronic pain.
Dr Negin Hesam-Shariati led the review with senior author Professor Sylvia Gustin, both from NeuRA's Centre for Pain IMPACT and the UNSW School of Psychology, finding that intensity of pain was influenced by psychosocial factors such as psychological distress, coping responses and social functioning.
"Pain is among the most common and disabling secondary health conditions following SCI, affecting approximately 50-80% of individuals and substantially contributing to long-term disability and reduced quality of life," said Prof Gustin.
"This review shows that pain after spinal cord injury is deeply interconnected with our psychological and social wellbeing," Dr Hesam-Shariati said.
"It reinforces what our growing understanding of pain has shown: that pain isn't just driven by damage to the nervous system but also shaped by mood, thoughts and social context. From this, we can identify potential targets for more personalised pain management for people living with spinal cord injury."
About the study
The systematic review and meta-analysis included 78 studies with nearly 20,000 participants that reported associations between pain intensity and psychosocial factors in adults with chronic SCI.
"Higher pain intensity was associated with greater fatigue, sleep disturbance, and anger, as well as lower self-perceived social functioning and quality of life and life satisfaction," Dr Hesam-Shariati said.
The review also examined whether demographic and injury-related characteristics, including sex, age, time since injury, and tetraplegia, influenced these associations, though the effects were limited and inconsistent.
"We found that the relationship people have with pain appears to change over time," Dr Hesam-Shariati said.
"Early after injury, people may be more likely to feel overwhelmed or distressed by pain, but over time, acceptance and psychological adjustment seem to become more important,"
The findings reflect the lived experience of many people with SCI.
"Medication helps, but it's not the whole answer," said Stuart Hurst, who lives with neuropathic pain after spinal cord injury.
"The support I've had with my mindset and coping has been just as important."
Treatments for SCI-related pain
Historically treatment for SCI-related pain has focused on the injury itself and medication management.
"SCI-related pain often remains resistant to treatment, with benefits typically partial, temporary, or limited by adverse effects, cost or restricted access," Prof Gustin said.
"However, pain is rarely just physical and factors like mental health, fatigue, coping and social connection can all shape how pain is experienced day-to-day."
The findings support a biopsychosocial model, one that recognises the biological, psychological and social factors involved in chronic pain.
"This research highlights the need to better understand the factors associated with persistent pain beyond biomedical mechanisms alone," Dr Hesam-Shariati said.
"The findings highlight modifiable targets such as depression, catastrophising, and self-efficacy that may inform psychologically informed interventions and multidisciplinary rehabilitation approaches. Understanding these psychosocial drivers is essential for developing more effective and personalised treatments."
Next steps
Further research is needed to improve mechanistic understanding and intervention development within neurorehabilitation frameworks.
"One important next step is developing and testing more integrated approaches to pain management," Dr Heram-Shariati said.
"We need to combine biomedical care with psychological and social support, rather than treating these as separate domains.
"We also need more longitudinal research to understand how pain and psychosocial factors influence one another over time after injury.
"This work will help us move towards more personalised integrated pain care for people living with spinal cord injury."
The Centre for Pain IMPACT continues to explore multidisciplinary approaches to pain care, including the importance of psychological support. The team will soon recruit for its NeurStim+ trial testing interventions for neuropathic pain after spinal cord injury. It is also running a Pain and Emotion Therapy trial and NeuroGame trial, both targeting chronic pain.
"Psychosocial factors associated with pain in spinal cord injury" was published in The Lancet Group's eClinicalMedicine and
