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The Beyond Pain Foundation

Conditions we support

Conditions guide

Spinal cord injury

A spinal cord injury changes how messages pass between the brain and the body. As well as affecting movement and feeling, it very often brings long-term pain. This guide explains the types of pain, how rehab works, the treatments available in the UK, and your rights when returning to work.

People in the UK living with a spinal cord injury
About 105,000
New injuries or diagnoses each year
About 4,400
Specialist spinal cord injury centres
10 across the UK
Have long-term pain
About 8 in 10

This guide is general information, not medical advice. Medicines and treatments must be prescribed or recommended for you by a doctor or pharmacist. We do not give doses here.

What a spinal cord injury is

The spinal cord is a bundle of nerves running down the middle of the spine. It carries messages between the brain and the rest of the body. When it is damaged, messages below the injury can be blocked or changed. This can affect movement, feeling, bladder, bowel, breathing, blood pressure and sexual function.

An injury can be caused by trauma, such as a fall, a road accident or a sports injury. It can also have other causes, such as pressure on the cord, a tumour, inflammation or an infection. About 4,400 people in the UK are injured or diagnosed each year, and about 105,000 people are living with a spinal cord injury.

How it affects you depends on where the injury is and how much of the cord is damaged:

  • Tetraplegia is an injury in the neck, which affects the arms, body and legs.
  • Paraplegia is an injury lower down, which affects the body and legs.
  • A complete injury means no messages get through below the injury. An incomplete injury means some do, so some movement or feeling remains. Incomplete injuries vary a lot from person to person.

Types of pain after a spinal cord injury

About 8 in 10 people with a spinal cord injury have long-term pain. Many say it affects their quality of life more than anything else. There are several kinds, and you may have more than one.

Nerve pain (neuropathic)

Burning, stabbing, shooting, electric or crushing pain caused by the damaged nerves themselves. It can be felt at the level of the injury or below it, even in parts of the body with no other feeling. It usually starts weeks or months after the injury.

Musculoskeletal pain

An aching pain, often in the neck, shoulders and back above the injury. It comes from overworked muscles and joints, for example from pushing a wheelchair or transferring.

Shoulder pain

A very common type of overuse pain for wheelchair users, because the shoulders do so much more work. It can threaten independence if it isn't managed.

Spasticity and spasms

Muscles below the injury can tighten or jerk without warning. Spasms can be painful, disturb sleep and make transfers hard. Infections or constipation can make them worse.

Visceral pain

Pain from inside the body, such as the bladder or bowel. It can be hard to pinpoint and may be a sign of a problem that needs checking.

Pain from the injury

Pain from broken bones, surgery and bruising early on. This usually settles as the injury heals.

Recovery and rehab stages

Everyone's recovery is different. Rehab after a spinal cord injury focuses on getting as much function back as possible, learning new ways to do things, and adjusting to life after injury.

  1. Hours to weeks

    Emergency and acute care

    Treatment in a major trauma centre or hospital, sometimes with surgery to stabilise the spine.

  2. Usually several months

    Specialist rehab

    Ideally in a spinal cord injury centre: physio, occupational therapy, wheelchair skills, bladder and bowel care and psychology.

  3. First months at home

    Going home

    Adapting your home and routines. Some centres offer a home visit within 6 months of leaving. Nerve pain often becomes clearer around now.

  4. Lifelong

    Living with your injury

    Regular follow-up from your spinal centre, managing pain and health, and getting back to work, study and activities.

Timings vary a lot depending on the level of injury and your other needs.

When to get urgent help

Autonomic dysreflexia is an emergency

If your injury is at T6 (mid-chest) or above, your blood pressure can suddenly rise to dangerous levels. It is usually set off by something below the injury, such as a full bladder, a blocked catheter, constipation, a pressure sore, an ingrown toenail or tight clothing. Signs include a pounding headache, flushing or blotchy skin and sweating above the injury, pale skin below it, blurred vision and a slow or irregular heartbeat.

Sit up, loosen clothing and look for the cause straight away, starting with the bladder. If you can't find and fix the cause quickly, call 999. Carry an emergency card so staff know what to do.

Call 999 if you have

  • signs of autonomic dysreflexia that don't settle quickly
  • new weakness, numbness or loss of bladder or bowel control after a fall or accident
  • difficulty breathing
  • signs of a serious infection, such as fever with confusion

Call NHS 111 if

  • you think you have a urine infection, especially with a fever
  • your spasms suddenly get much worse
  • a leg becomes swollen, hot or red
  • you have a pressure sore that is getting worse

See your GP or spinal centre if

  • you have new or worse pain
  • your sensation or strength is changing
  • shoulder pain is making transfers or pushing harder
  • you feel low, anxious or are sleeping badly

Assessment and referral

After an injury, doctors use scans and a detailed check of movement and feeling to find the level of injury and whether it is complete or incomplete. If you are newly injured, ask to be referred to one of the UK's specialist spinal cord injury centres. Charities report that only a third to a half of recently injured people get specialist care, so it is worth asking early.

There are 7 centres in England and one each in Scotland, Wales and Northern Ireland. Once you are known to a centre, it should offer lifelong follow-up, and you can usually contact it with problems related to your injury. Your GP can also refer you to an NHS pain clinic or a spasticity service.

Pain is assessed by asking where it is, what it feels like, and when it started. Telling apart nerve pain, overuse pain and spasms helps your team choose the right treatment.

Treatments and medicines

Pain after a spinal cord injury can be hard to treat, and it often takes time to find the right mix. Most people do best with a combination of medicine, physical therapy and psychological support.

Nerve pain medicines

Prescription from your GP, spinal centre or pain clinic

NICE suggests amitriptyline, duloxetine, gabapentin or pregabalin as first choices for nerve pain. If one doesn't work or causes side effects, another can be tried. They usually take a few weeks to work fully. Ordinary painkillers rarely help nerve pain.

Simple painkillers

From a pharmacy, or prescribed

Paracetamol and anti-inflammatories such as ibuprofen can help musculoskeletal and overuse pain. Ask a pharmacist if they are safe with your other medicines.

Spasticity medicines

Prescription

Baclofen is the medicine most often used for spasms. Others include tizanidine. They can cause drowsiness, so changes are usually made slowly.

Botulinum toxin

Injections from a specialist

For spasticity in particular muscles. The effect wears off, usually after about 3 months, so injections are repeated if they help.

Opioids

Prescription, usually short term

Strong painkillers may be used early on, after the injury. NICE says tramadol should only be used for short-term "rescue" of nerve pain, not long-term. Long-term opioids carry risks of dependence and constipation.

Specialist treatments

Spinal centres and pain clinics

For severe pain or spasticity: a baclofen pump placed under the skin, spinal cord stimulation, and, rarely, surgery on the nerves. These need careful specialist assessment.

Don't stop medicines suddenly

Nerve pain medicines such as pregabalin and gabapentin, and spasticity medicines such as baclofen, should be reduced slowly with your doctor's advice. Stopping them suddenly can cause withdrawal effects. Many of these medicines also cause drowsiness, which matters if you drive.

Specialist and rehab options

  1. Spinal cord injury centre rehab

    Usually several months as an inpatient

    A team including physiotherapists, occupational therapists, nurses, psychologists and doctors. Rehab covers strength and movement, wheelchair skills, daily tasks, equipment, bladder and bowel care, and emotional adjustment.

  2. Lifelong follow-up

    Regular reviews for life

    Outpatient clinics and outreach teams from your spinal centre. Some offer advice on employment, housing and care.

  3. Physiotherapy and exercise

    Ongoing, with blocks of therapy when needed

    Stretching, strengthening, standing and posture work help spasticity and overuse pain. Some centres offer hydrotherapy.

  4. Pain clinic and pain management programmes

    If pain stays severe or limits your life

    Medicines, injections, TENS, acupuncture and psychological approaches such as cognitive behavioural therapy. Group programmes usually run over several weeks.

  5. Seating and wheelchair review

    Whenever posture, pain or skin changes

    The right wheelchair, cushion and seating can reduce shoulder, back and neck pain and protect your skin. Ask your wheelchair service for a review.

Self-help and living well

Protecting your body

  • Look after your shoulders: avoid unnecessary reaching and transfers
  • Keep up the stretches and exercises your physio gives you
  • Check your skin every day for pressure marks
  • Keep to a good bladder and bowel routine. Problems here can worsen spasms and pain
  • Get your seating checked if pain changes

Managing pain and energy

  • Pace your activities and plan rest
  • Notice what makes pain worse, such as stress, poor sleep or cold
  • Try relaxation, distraction or mindfulness
  • Stay active in ways that suit you, such as adaptive sport
  • Talk to others who understand: peer mentors can help a lot

Over time, many people find that pain becomes one part of life rather than the centre of it. Building a life around things you value, with support, is a big part of living well with long-term pain.

Tips for getting the best treatment

Keep a pain and spasm diary

Write down where pain is, what it feels like, when it happens, and anything that seems linked: bladder, bowel, skin, sleep, activity or stress. This helps your team spot triggers and tell nerve pain from overuse pain.

  • If you are newly injured, ask to be referred to a spinal cord injury centre
  • Know how to contact your spinal centre between appointments
  • Ask: "What type of pain is this?" and "What can we try next?"
  • Ask for a referral to a pain clinic or spasticity service if pain isn't controlled
  • Carry an autonomic dysreflexia card if your injury is at T6 or above
  • You can ask your GP for a second opinion if treatment isn't working
  • Carers can ask their council for a carer's assessment

Spinal cord injury and work

A spinal cord injury will almost always count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland). Your employer must make reasonable adjustments so you are not at a disadvantage. Examples include:

  • Step-free access and an accessible toilet
  • A height-adjustable desk
  • A supportive chair, or space for your wheelchair
  • Voice recognition software
  • Adapted keyboards, mice or trackballs
  • A phased return to work
  • Flexible hours and working from home
  • Breaks for pain, pressure relief and personal care
  • A parking space close to the entrance
  • Time off for appointments

Access to Work can help pay for specialist equipment, a support worker, vehicle adaptations or taxis to work if you can't use public transport. You apply for it yourself. The Back Up Trust runs free courses and one-to-one support to help people with a spinal cord injury get back to work.

Someone every 2 hours is injured or diagnosed with a spinal cord injury in the UK. (Spinal Injuries Association, 2024)

Benefits

If you are off sick, you may get Statutory Sick Pay. You may be able to get Personal Independence Payment (PIP), or Adult Disability Payment in Scotland, whether or not you work. If you can't work or are on a low income, you may qualify for Universal Credit or Employment and Support Allowance. Turn2us, Citizens Advice and Aspire can help you check.

How The Beyond Pain Foundation can help

If NHS waits are too long, or the help you need isn't available to you on the NHS, we may be able to fund:

  • A course of private physiotherapy, hydrotherapy or specialist neurological rehab
  • A private consultation with a pain specialist
  • A pain management programme
  • A TENS machine or other device recommended by your clinician
  • Workplace or home equipment, such as a height-adjustable desk, voice recognition software, adapted keyboard or pressure-relieving cushion

We fund treatment, equipment and support, not general living costs. If Access to Work, your employer, the NHS or your council should provide something within a reasonable time, we'll ask you to try them first. Always get a written quote to include with your application.

Apply for funding Check the requirements

Support and sources

Spinal Injuries Association

Support, advice and peer support

Freephone support line 0800 980 0501. Also specialist nurses, peer support, counselling and advocacy.

spinal.co.uk

Back Up

Mentoring, courses and work support

Mentoring from people with lived experience, wheelchair skills and back-to-work courses. Call 020 8875 1805.

backuptrust.org.uk

Aspire

Practical help after injury

Support in hospital and after, accessible housing, and help with benefits. Call 020 8954 5759.

aspire.org.uk
Sources for this guide

Last reviewed: October 2026.