Mapping the discourse on neuropathic pain after spinal cord injury: A signal-generation natural language processing study of Reddit communities

Spinal Cord. 2026 Oct 12. doi: 10.1038/s41393-026-01286-y. Online ahead of print.

ABSTRACT

STUDY DESIGN: Cross-sectional natural language processing (NLP) study of publicly available Reddit data.

OBJECTIVES: To map the thematic structure and affective tone of neuropathic pain discourse among Reddit users self-identifying with spinal cord injury (SCI) or clinically overlapping cord and cauda pathology, and to surface candidate hypotheses for triangulation with patient-reported and clinical data.

SETTING: Public Reddit communities.

METHODS: Searches across ten subreddits using twenty query strings yielded 1489 candidate posts. A two-tier keyword filter (SCI-spectrum population term plus a pain or treatment term) retained 517 unique documents from six communities. Documents were embedded with a sentence-transformer model, reduced with Uniform Manifold Approximation and Projection (UMAP), and clustered using KMeans (K = 10) within a BERTopic representation pipeline, with the cluster count and cluster labels informed by a lexically derived seed-topic list. Cluster stability and sensitivity to the choice of K were assessed. Themes were characterised by class-term frequency-inverse document frequency (TF-IDF) keywords and provisional large language model labelling. Sentiment was assigned using a RoBERTa classifier fine-tuned on social media text; because the classifier was not calibrated in this clinical domain, sentiment proportions are reported as directional, ordinal signals rather than calibrated estimates. Engagement was operationalised as median upvote score and comment count per theme.

RESULTS: The corpus was dominated by r/spinalcordinjuries (41%) and r/ChronicPain (23%). Overall sentiment was negative in 56.1% of posts (uncalibrated). Ten interpretable themes were identified within this two-community corpus. The highest negative-sentiment shares were in Treatment-Refractory Pain and Psychological Burden, Opioid and Polypharmacy Management Challenges, and Severe Spasticity Progression; the lowest were in Spinal Cord Stimulation Devices and Advanced Neuromodulation. Engagement was highest for crisis narratives (median upvote score 13) and opioid-management discourse (median 22 comments).

CONCLUSIONS: Within the sampled Reddit communities, discourse on neuropathic pain in SCI and overlapping cord/cauda pathology is dominated by negative affect, treatment refractoriness, and psychosocial burden, while emerging neuromodulation themes attract comparatively less negative sentiment. Findings are signal-generating, require triangulation with clinical data, and should not be read as representative of the broader SCI population.

SPONSORSHIP: None.

PMID:42864414 | DOI:10.1038/s41393-026-01286-y