A Cognitive Behavioural Therapy Pain Management Programme for Neuropathic Pain Post Spinal Cord Injury: A Feasibility Study Including the Clinician and Patient Perspectives

Abstract

Objective: To evaluate the feasibility of a cognitive behavioural therapy pain management programme for managing neuropathic pain post-spinal cord injury.Design: A mixed methods prospective feasibility trial. Setting:A national rehabilitation hospital. Subjects:Adults with neuropathic pain post-spinal cord injury. Methods:Following ethical approval, participants were recruited from a spinal cord injury outpatient service. A multi-disciplinary team delivered the programme twice a week over five weeks. Changes in study outcome measures addressing quality of life, mood and sleep indices over three time periods were analysed using Friedman's test. Differences from baseline to intervention completion and six months follow-up intervals were analysed using Wilcoxon sign-rank test. Significance was set p<0.05. Post-intervention qualitative feedback was obtained from programme participants and the clinicians involved.Results: Eight participants completed the programme. Significant improvements were noted post-intervention in the psychological domain of the World Health Organisation Quality of Life Bref (Z=-2.120; p=0.03) and the depression score (Z=-2.555; p=0.01) of the Hospital Anxiety and Depression Scale, remaining significantly improved at six months follow-up when compared to baseline (Z=-2.533; p=0.01). Transportation was the main barrier to recruitment. Qualitative feedback highlighted the positive impact for participants in coping with pain. Clinicians noted many positive outcomes of the programme, whilst highlighting health-systems difficulties in implementation. Conclusions:A cognitive behavioural therapy pain management programme is perceived as beneficial by individuals with neuropathic pain after spinal cord injury, a finding supported by quantitative data analysis. Recruitment barriers to programme delivery indicate that alternate modes of delivery warrant consideration.

Psychologically based interventions for adults with chronic neuropathic pain: a scoping review

“…A range of NeuP conditions were studied, but overall, painful diabetic peripheral neuropathy was the most common (27%, n = 9), 41 , 43 , 50 , 51 , 55 , 57 , 59 , 60 , 63 closely followed by NeuP associated with SCI (24%, n = 8). 12 , 30 , 32 , 45–47 , 49 , 68 Four (12%) studies included individuals with phantom limb/breast pain. 52 , 64–66 There were 3 (9%) studies each for multiple NeuP conditions 31 , 44 , 48 and for postherpetic neuralgia.…”

An internet‐delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: A randomized controlled trial

“…The investigation of the efficacy of CBT‐PMPs specifically for SCI pain is limited. Only four studies have examined this approach in centre‐based formats; one RCT (Heutink et al, ) and four cohort studies (Burke, Lennon, et al, ; Burns et al, ; Norrbrink Budh et al, ; Perry et al, ) Our RCT is the first to explore internet‐delivered CBT‐PMPs, with only a single group feasibility study available for direct comparison (Dear et al, ). Hence, we believe the SPIRE trial adds to the emerging body of evidence in this field.…”

“…Sample size calculation, with 80% of power and p < 0.05 was based on the ability to detect a significant difference in the psychological domain of the World Health Organization WHOQOL‐Bref (WHOQOL Group, ), as guided by the findings and data from the centre‐based study conducted by this research team (Burke, Lennon, et al, ). No clinically meaningful change is published for this outcome measure and as such the change to be detected was the reliable change index, calculated as per the Jacobson and Truax method () (Jacobson & Truax, ).…”

“…This internet‐delivered CBT‐PMP was developed from a hospital‐based CBT‐PMP (Burke, Lennon, et al, ) and adapted within an established holistic framework (van Gemert‐Pijnen et al, ) involving key stakeholders including the end‐users, SCI rehabilitation clinicians, pain specialists and an education technologist (e‐health technology expertise). A SPIRE prototype which aligned to pre‐defined end‐user preferences was developed by a multi‐disciplinary project management group and evaluated by potential end‐users and further key stakeholders using qualitative methodology.…”

“…To date, five centre‐based studies (5–10 week duration) have tested programmes specific to SCI pain. One randomized controlled trial (RCT) and four cohort studies showed promising effectiveness for improving mood profiles, pain interference, pain intensity and participation in daily life (Burke, Lennon, et al, ; Burns, Delparte, Ballantyne, & Boschen, ; Heutink et al, ; Norrbrink Budh, Kowalski, & Lundeberg, ; Perry, Nicholas, & Middleton, ). Difficulties in programme recruitment due to the relative rarity of the condition by geographical location, transportation issues, the need for onsite accommodation in some cases and the specialized nature of the intervention were highlighted (Burke, Lennon, et al, ; Burns et al, ; Perry et al, ).…”