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RehabMeasures Instrument

Classification for Chronic Pain in SCI/Cardenas Pain Classification

Last Updated

Purpose

The Classification for Chronic Pain in Spinal Cord Injury (SCI) classifies pain after SCI as either neurologic or musculoskeletal pain and further into one of six subcategories.

This pain classification is a system for classifying type of pain rather than a true outcome measure that can measure change in pain over time.

Link to Instrument

Area of Assessment

Pain

Assessment Type

Patient Reported Outcomes

Cost

Free

Diagnosis/Conditions

  • Spinal Cord Injury

Populations

Key Descriptions

  • 2 categories of pain:
    1) Neurologic
    2) Musculoskeletal
  • Neurologic Pain is sub-classified into:
    1) SCI Pain
    2) Transition Zone Pain
    3) Radicular Pain
    4) Visceral Pain
  • Musculoskeletal pain is subclassified into:
    1) Mechanical Spine Pain
    2) Overuse Pain
  • Classification is determined via interview or questionnaire.

Number of Items

6

Time to Administer

5-15 minutes

Required Training

No Training

Instrument Reviewers

Initially reviewed by Rachel Tappan, PT, NCS and the SCI EDGE task force of the Neurology Section of the APTA in 3/2012.

ICF Domain

Body Structure

Measurement Domain

Sensory

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 months post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

NR

NR

NR

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

NR

NR

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

No

No

Not reported

Considerations

The Classification for Chronic Pain in SCI/Cardenas Pain Classification is one of many systems that have been developed to classify pain in people with spinal cord injury. A group of experts met in 2009 and developed a new pain classification system for people with spinal cord injury (the ISCIP classification), which incorporates elements of the many pre-existing classification systems. Consider using the ISCIP classification system rather than the Classification for Chronic Pain in SCI/Cardenas Pain Classification for consistency of pain classification across settings.

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Spinal Injuries

back to Populations

Interrater/Intrarater Reliability

Chronic SCI:

(Cardenas et al, 2002; = 163; mean time post-SCI = 8.3 (8.9) years)

Interrater reliability tested on subset of subjects, = 56

  • Adequate Interrater Reliability (kappa = 0.66-0.68)

Content Validity

SCI:

(Bryce et al, 2007; = 59 participants in a course on outcome measures at a meeting of American Spinal Injury Association and the International Spinal Cord Society)

  • In a vote on validity and usefulness, the Cardenas Pain Classification was determined to be less valid and useful than both the Bryce-Ragnarsson Pain Taxonomy (BRPT) and the International Association for the Study of Pain (IASP) SCI Classification.

Voting on Pain Classification Validity/Usefulness:

Instrument

Valid and useful % (N)

Useful but requires more validation % (N)

Useful but requires changes/improvement then further validation % (N)

Not useful or valid for research in SCI % (N)

Cardenas

4 (2)

20 (11)

52 (29)

25 (14)

BRPT

14 (8)

42 (25)

36 (21)

8 (5)

IASP

19 (11)

47 (28)

31 (18)

3 (2)

BRPT: Bryce Ragnarsson Pain Taxonomy

IASP: International Association for the Study of Pain Scale

Bibliography

 

Bryce, T. N., Budh, C. N., et al. (2007). "Pain after spinal cord injury: an evidence-based review for clinical practice and research: Report of the National Institute on Disability and Rehabilitation 嫩B研究院 Spinal Cord Injury Measures meeting." The journal of spinal cord medicine 30(5): 421.

Cardenas, D. D. and Felix, E. R. (2009). "Pain after spinal cord injury: a review of classification, treatment approaches, and treatment assessment." PM R 1(12): 1077-1090.

Cardenas, D. D., Turner, J. A., et al. (2002). "Classification of chronic pain associated with spinal cord injuries." Archives of Physical Medicine and Rehabilitation 83(12): 1708-1714.