Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics

Abstract

Study design: Postal survey. Objectives: Because of the high prevalence and inadequate control of pain following spinal cord injury (SCI), it is important to have information about the factors associated with the use of specific pain therapies. We conducted this study to evaluate the ability of pain characteristics and psychosocial factors to predict the use of treatments. Setting: The Miami Project to Cure Paralysis (Miami, FL, USA). Methods: People with SCI (n ¼ 120) were mailed a packet containing a questionnaire with questions regarding demographic factors, pain characteristics, and pain treatments along with a copy of the Multidimensional Pain Inventory. Results: A total of 59% of the respondents had been prescribed treatment or self-initiated efforts to treat pain over the previous 18-month period. The most common treatments used by this sample were massage (26.6%), opioids (22.5%) and nonsteroidal anti-inflammatory drugs (NSAIDs) (20%). The most effective treatments overall were 'physical therapies' with 50% receiving these treatments indicating that their pain was 'considerably reduced' or that they were 'pain free.' Opioids and anticonvulsants were perceived to be the most effective pharmacological agents prescribed (33.3 and 23.8% reporting their pain was considerably better or eliminated, respectively). People using prescription medication reported significantly greater pain severity, more widespread pain, more descriptive adjectives, more evoked pain, greater difficulty in dealing with pain, and more interference and decreased activity levels due to pain, compared to people not using prescription medication. A combination of greater difficulty in dealing with pain, intense pain, presence of evoked pain, and higher level of perceived support from significant others was predictive of taking prescription medication. Conclusion: People taking prescription medication reported significantly more intense pain with neuropathic characteristics that significantly affected daily life and routine activities. A substantial percentage of individuals with pain related to SCI did not obtain significant pain relief from prescription medications. None of the factors assessed predicted the use of nonprescription treatments. The results of this study confirm the inadequacy of available modalities to manage chronic pain related to SCI.

Chronic pain after spinal cord injury: What characteristics make some pains more disturbing than others?

“…The finding that MD pains are intense and constant, interfere with daily living, and are aggravated by many factors adds to the body of literature that suggests that current treatments for pain in the SCI population are mostly insufficient [8,[16][17][18][19][20][21]. Pains that are severe, exacerbated by various stimuli encountered on a daily basis, and constantly present are bound to significantly interfere with activities of life beyond the functional limitations imposed by the SCI itself.…”

“…The presence of chronic pain has been reported to decrease quality of life after SCI [2,[10][11][12] and to frequently interfere with both sleep and common daily activities [2,[5][6]8,13]. Chronic pain in individuals with SCI is particularly problematic because several types of pain may exist simultaneously [2,[6][7][8][9][14][15], and many of these pains are refractory to currently available treatments [8,[16][17][18][19][20][21]. Because pain in this patient population is heterogeneous and persons with SCI often present with more than one type of pain, each pain should be evaluated separately to the extent possible.…”

The impact of morphine after a spinal cord injury

“…These results are alarming given the widespread use of morphine for the clinical treatment of pain after a spinal cord injury [61,62]. If one injection of morphine can affect recovery, the potential consequences of long-term treatment could be substantial.…”

Impact of spinal cord injury on self-perceived pre- and postmorbid cognitive, emotional and physical functioning

“…Physical exercise is also important, both for the management of pain and for the psychological benefits that flow from increased physical activity. 45 Research suggests that individuals with SCI can be 'immunized' against anxiety and depression if cognitive behavior therapy is provided early on in their rehabilitation following injury. 19 The third part of our study examined changes in function over time with a comparison between a newly injured group and a similar group with established injuries and by performing two assessments separated by a 6-month period.…”