September 2022

Welcome to the SCI Line

Welcome to another issue of SCI Line, a quarterly digest on recent and relevant content on spinal cord injury (SCI) research, practice, and resources for clinicians. 

Our Spring edition explored the medical and psychosocial factors impacting chronic pain after SCI, and reviewed the Canadian Pain Spinal Cord Injury Clinical Practice Guidelines (CanPain SCI Guidelines). The next three SCI Line Issues will further explore pain management strategies for managing chronic neuropathic pain, with a focus on the effectiveness of Cannabinoids, Spinal Cord Stimulation, and Mindfulness from the perspective of the clinical expert and person with lived experience (PLEX). 

Want to connect with other clinicians?
Access the Canadian Spinal Cord Injury Clinician Directory.

We hope you enjoy this edition of SCI Line. Your feedback is important to us, and we welcome suggestions for future content. Please connect with our team at

Thank you,
Praxis Spinal Cord Institute Clinical Team
Jess (RN), Kris (PT), Gwen (OT), Shannon (OT)  

Managing chronic pain has been reported as one of the most important factors impacting quality of life for people after SCI, with the incidence of pain following SCI ranging from 48 – 92 %. Pain is complex, and can be a very individual experience impacted by overall physical health and psychosocial factors, making it difficult to find effective treatment solutions.  

The different types of pain that a person can experience after SCI - musculoskeletal, neuropathic, visceral - as well as the individual’s response to medications and treatments, leads to the complexity of pain management. In our Spring SCI Line issue, we reviewed the Canadian Pain Spinal Cord Injury Clinical Practice Guidelines (CanPain SCI Guidelines), which are specific to adults with SCI within the rehabilitation and community settings, and encompass model of care, screening, diagnosis and treatment.

Find the full guidelines here:
CanPain SCI Guidelines: 2021.

Find a summary of the guidelines here:
Summary of CanPain SCI Guidelines: 2021 

In this newsletter learn about:

The CanPain SCI Guidelines recommend pharmacology treatment of pregabalin, gabapentin or amitriptyline as first-line treatment options for managing neuropathic pain after SCI. Cannabinoids are recommended under the secondary treatment options for consideration in the management of chronic pain after SCI.

There are several sources of Cannabinoids; they occur naturally in the body (endocannabinoids), and in cannabis plants (phytocannabinoids), and they can also be created in a lab (synthetic cannabinoids). 

Cannabinoids from any of these sources act on cannabinoid receptors within the cells in the body which can then affect pain, memory, appetite, and immune responses. The cannabis plant produces over 60 cannabinoid compounds, including the commonly known psychotropic cannabinoid Δ9-tetrahydrocannabinol (THC) and the non-psychoactive cannabidiol (CBD).

These compounds have been recognized by the medical community as a treatment option for people with health conditions such as anxiety, depression, pain and insomnia. Synthetic cannabinoids are only available by prescription and refers to Nabilone - in pill form, or Sativex - an oral spray. Cannabis, with varying levels of CBD or THC, is available by medical authorization or private purchase and can be taken orally, applied to the skin with topical creams or inhaled – smoking or vaporizing. Whether obtained by medical authorization or private purchase, cannabis is provided by licensed producers that are authorized and monitored by Health Canada to ensure quality and purity.

As with most treatments and pharmaceuticals, the benefits and side effects of using cannabinoids varies substantially between individuals.

Check out an information package from Canadian Public Health Association on Cannabasics

Sam Douglas

Sam works at Praxis Spinal Cord Institute in the position of Global Research Platform & BC Programs Support. He sustained a C5 AIS D spinal cord injury (SCI) on March 22, 2017 after a nearly 30-foot fall onto concrete in downtown Vancouver, BC. He shares his perspective on exploring Cannabinoids to assist with managing his chronic neuropathic pain.

Read Interview ->

Karen Ethans

Karen is a Physiatrist, Director of the Spinal Cord Unit at Winnipeg’s Health Science Centre, and Associate Professor at the University of Manitoba. She has dedicated her medical career to maximizing recovery for people with SCI, with a special interest in managing neuropathic pain and spasticity. She discusses the benefits of cannabinoids for people with SCI.

Read Interview ->

Cannabinoids 101: Understanding the endocannabinoid system with Dr. Hill
In this webinar, Dr. Hill uncovers the basic workings of the endocannabinoid system, what we know about how cannabis use effects the brain, and the limitations of past approaches to studying cannabis use in key areas of mental health such as schizophrenia and psychoses.

Watch Here

SCIRE Professional: Current best practice and evidence based resources for Cannabis (Marijuana) and Cannabinoids

Read More

Chronic Pain after Spinal Cord Injury: Results of a Long-Term Study Modirian E, Pirouzi P, Soroush M, Karbalaie-Esmaeili S, Shojaei H, Zamani H . Chronic pain after spinal cord injury: results of a long-term study. Pain Med 2010; 11: 1037–1043.

Read Paper

The Therapeutic Potential and Usage Patterns of Cannabinoids in People with Spinal Cord Injuries: A Systematic Review 
Nabata KJ, Tse EK, Nightingale TE, Lee AHX, Eng JJ, Querée M, Walter M, Krassioukov AV. The Therapeutic Potential and Usage Patterns of Cannabinoids in People with Spinal Cord Injuries: A Systematic Review. Curr Neuropharmacol. 2021;19(3):402-432.  

Read Paper

Using cannabis for pain management after spinal cord injury: a qualitative study
Bourke, J.A., Catherwood, V.J., Nunnerley, J.L. et al. Using cannabis for pain management after spinal cord injury: a qualitative study. Spinal Cord Ser Cases 5, 82 (2019).

Read Paper

A randomized, double-blinded, crossover pilot study assessing the effect of nabilone on spasticity in persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation.
Pooyania S, Ethans K, Szturm T, Casey A, Perry D. 2010; 91(5):703-707.

Read Paper

Want to learn more about cardiometabolic risk in SCI? Circulus Primary SCI Network is hosting a webinar on Cardiometabolic risk in Spinal Cord Injury presented by Dr. Cathy Craven

Wednesday September 21st, 2022 | 12:00-1:00pm EST 

Register Here
International SCI Conference (ISCoS 2022) 61st Annual Scientific Meeting Sept 15 – 18, 2022 Vancouver
EUROSPINE 2022  Oct 19 - 21, 2022 Milan, Italy
ACRM 2022 Annual Meeting American Congress of Rehabilitation Medicine Nov 8 - 11, 2022 Chicago
12th World Congress for Neurorehabilitation Dec 14 - 17, 2022 Vienna, Austria

We hope you enjoyed this edition of SCI Line. Your feedback is important to us, and we welcome suggestions for future content. Please connect with our team at

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Praxis Spinal Cord Institute is a Canadian-based not-for-profit organization that leads global collaboration in spinal cord injury research, innovation and care. By using SCI knowledge translation to bridge health evidence with real world delivery, we work to make exceptional improvements in the health of people living with SCI.

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