A Mixed-methods Study of a Multimodal Non-pharmacological Pain Program for Spinal Cord Injury

Background & Aims

Up to 80% of individuals develop chronic pain within their first year after a spinal cord injury (SCI).1 Persistent neuropathic pain negatively influences quality of life2 and independent living after SCI by interfering with sleep, mood, physical and social activities.3,4 Exclusive pharmacological treatments have limited effectiveness in reducing the intensity and impact of SCI-related neuropathic pain, therefore there is a growing need to develop multimodal patient-centered pain management strategies. Additionally, pain management after SCI should consider patients’ perspectives.5 The long-term goal of this study is to facilitate the development of effective clinical SCI neuropathic pain trials and programs that are tailored to consumers’ preferences and specific pain characteristics.

Methods

The present study utilized a mixed-method convergent design to explore the first-hand experiences and effects of a 10-week pain program involving 34 people with SCI who experienced moderate to severe neuropathic pain. Participants took part in four weekly pain educational group sessions that were followed by six weeks of biweekly upper body exercise and bodily illusion, to target multiple pain mechanisms. Participants underwent three qualitative interviews concerning their perspectives on each of the program components in an open-ended format. The interviews were transcribed and independently analyzed based on grounded theory. Measures of neuropathic pain characteristics and psychosocial factors were evaluated at baseline, after the education sessions, and exercise/bodily illusion sessions. Here we present a subset of data including qualitative interviews and quantitative measures before and after study sessions. Data collection is ongoing.

Results

The interview findings supported the usefulness of pain education, and some wished they had this information early after injury. Some felt that understanding their pain and treatment options helped them to better communicate with their healthcare providers. After the exercise/bodily illusion sessions, some experienced less pain and were able to participate in activities for longer periods without exacerbation of pain. However, others reported difficulty engaging in the bodily illusion and suggested using more tailored illusions and adding lower extremity exercises. Compared to baseline, significant mean improvements for overall pain severity (0.78/6.00; p=0.006) and total neuropathic pain symptom severity (13.7/50; p=0.002) were found after completing the exercise/bodily illusion sessions. After completion, lower overall pain severity, neuropathic pain symptom severity, and affective distress were associated with having more days with manageable pain (r=0.43-0.52; p= 0.03-0.007).

Conclusions

Because neuropathic pain after SCI is complex with multiple underlying mechanisms, comorbidities, and contributing factors; a multimodal approach to pain management is needed.6 Previous studies in this population suggest that having access to non-pharmacological interventions and more information about pain and treatment options are significant needs.7 Therefore, a better understanding of SCI stakeholder perspectives on pain education and non-pharmacological approaches merited further investigation.. The present study expands on this often underappreciated component of pain management and documented first-hand experiences of those living with neuropathic pain as they moved through the 10-week program. We found encouraging effects across indices of pain and psychosocial factors of pain including how to optimize these approaches for people with SCI who experience this challenging condition. Funded by Department of Defense SCIRP program #SC200152.

References

1.Finnerup NB, Norrbrink C, Trok K, Piehl F, Johannesen IL, Sørensen JC, et al. Phenotypes and Predictors of Pain Following Traumatic Spinal Cord Injury: A Prospective Study. J Pain 2014;15:40–8. https://doi.org/10.1016/j.jpain.2013.09.008.

2.Ravenscroft A, Ahmed YS, Burnside IG. Chronic pain after SCI. A patient survey. Spinal Cord 2000;38:611–4. https://doi.org/10.1038/sj.sc.3101073.

3.Rubinelli S, Glässel A, Brach M. From the person’s perspective: Perceived problems in functioning among individuals with spinal cord injury in Switzerland. J Rehabil Med 2016;48:235–43. https://doi.org/10.2340/16501977-2060.

4.Widerström-Noga EG, Felipe-Cuervo E, Yezierski RP. Chronic pain after spinal injury: Interference with sleep and daily activities. Arch Phys Med Rehabil 2001;82:1571–7. https://doi.org/10.1053/apmr.2001.26068.

5.Widerström-Noga E, Anderson KD, Perez S, Martinez-Arizala A, Cambridge JM. Subgroup Perspectives on Chronic Pain and Its Management After Spinal Cord Injury. J Pain 2018;19:1480–90. https://doi.org/10.1016/j.jpain.2018.07.003.

6.Guy SD, Mehta S, Casalino A, Côté I, Kras-Dupuis A, Moulin DE, et al. The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: Recommendations for treatment. Spinal Cord 2016;54 Suppl 1:S14-23. https://doi.org/10.1038/sc.2016.90.

7.Widerström-Noga E, Anderson KD, Perez S, Hunter JP, Martinez-Arizala A, Adcock JP, et al. Living With Chronic Pain After Spinal Cord Injury: A Mixed-Methods Study. Arch Phys Med Rehabil 2017;98:856–65. https://doi.org/10.1016/j.apmr.2016.10.018.

Presenting Author

Marlon Wong

Linda Robayo

The Miami Project, University of Miami, Miller School of Medicine

Lead Author

E-mail

Patient Engagement and Co-Creation in Research and Education

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A Mixed-methods Study of a Multimodal Non-pharmacological Pain Program for Spinal Cord Injury

Background & Aims

Methods

Results

Conclusions

References

Presenting Author

Marlon Wong

Poster Authors

Marlon Wong

Kim Anderson

Nicholas Cherup

Linda Robayo

Gabriel Fernandez

Roberta Vastano

Mark Nash

Kathryn Roach PT

Eva Widerström-Noga, DDS, PhD, FASIA

Topics

IASP 2024 World Congress on Pain