SCI and Chronic Pain Management

For many persons with spinal cord injury (SCI), living with and managing pain are major challenges that can have a tremendous impact on quality of life and the ability to carry out daily activities.

Ida had been an avid skier and hiker, and passionate swimmer for most of her life. At the age of 54 she was involved in a major ski accident that changed her whole life.

During the assessment phase of Ida's Rehab-Cycle^® the rehabilitation team conducted a comprehensive assessment. It involved an interview with Ida to gain an understanding of her needs and functioning status, including pain experience, from Ida's perspective (patient perspective). It also involved diverse discipline-specific clinical examinations and tests (health professional perspective). The assessment results served as the basis for setting Ida's Rehab-Cycle^® goals.

Having a comprehensive overview of Ida's functioning based on the rehabilitation team's assessment and Ida's statements about her pain experience and other aspects of functioning helped them to identify mutual goals to reach during rehabilitation as well as specific targets to address with interventions.

Ida's rehabilitation team, who was charged with implementing the comprehensive, interdisciplinary rehabilitation and pain management programme, comprised of a physician, nursing staff, a physical therapist, a sports therapist, an occupational therapist, a psychologist, and a social worker.

Ida's pain experience and functioning status were assessed again at the end of Ida's Rehab-Cycle^® to see which of the goals set at the beginning of the Rehab-Cycle^® were achieved and to inform further healthcare decisions.

Living with and managing chronic pain is a common experience of persons living with spinal cord injury (SCI). Irrespective of type or severity of pain, post-SCI pain can impact all aspects of a person's life.

1. Teasell RW, Mehta S, Aubut J, Foulon BL, Wolfe DL, Hsieh JTC, Townson AF, Short C. Pain following spinal cord injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Mehta S, Sakakibara BM, Eds. Spinal Cord Injury Rehabilitation Evidence, Version 3.0. Vancouver: Spinal Cord Injury Rehabilitation Evidence. 2010. p. 1-65.
2. Richards JS, Siddall P, Bryce T, Dijkers M, Cardenas DD. Spinal cord injury pain classification: History, current trends, and commentary. Top Spinal Cord Inj Rehabil. 2007; 13(2): 1-19.
3. Widerström-Noga EG. Neuropathic pain after spinal cord injury. In: Kirshblum S, Campagnolo DI. (eds.) Spinal cord medicine. Philadelphia, Pennsylvania (USA): Lippincott Williams & Wilkins; 2011. p. 482-499.
4. Boldt I, Eriks-Hoogland I, Brinkhof MWG, de Bie R, Joggi D, von Elm E. Non-pharmacological interventions for chronic pain in people with spinal cord injury. Cochrane Database Syst Rev. 2014; Issue 11: CD009177.
5. Burke D, Fullen BM, Stokes D, Lennon O. Neuropathic pain prevalence following spinal cord injury: A systematic review and meta-analysis. Eur J Pain. 2017; 21: 29-44.
6. van Gorp S, Kessels AG, Joosten EA, van Kleef M, Patijn J. Pain prevalence and its determinants after spinal cord injury: A systematic review. Eur J Pain. 2015; 19(1): 5-14.
7. Störmer S, Gerner HJ, Grüninger W, Metzmacher K, Föllinger S, Wienke C, Aldinger W, Walker N, Zimmermann M, Paeslack V. Chronic pain/dysaesthe­siae in spinal cord injury patients: Results of a multicentre study. Spinal Cord. 1997; 35: 446-455.
8. Müller R, Brinkhof MWG, Arnet U, Hinrichs T, Landmann G, Jordan X, Béchir M for the SwiSCI Study Group. Prevalence and associated factors of pain in the Swiss spinal cord injury population. Spinal Cord. 2016 Nov 15. In print.
9. Cardenas DD, Turner JA, Warms CA, Marshall HM. Classifications of chronic pain associated with spinal cord injuries. Arch Phys Med Rehabil. 2002; 83(12): 1708-1714.
10. Widerström-Noga E, Biering-Sørensen F, Bryce T, Cardenas DD, Finnerup NB, Jensen MP, Richards JS, Siddall PJ. The international spinal cord injury pain basic data set. Spinal Cord. 2008; 46(12): 818-823.
11. Bryce TN, Biering-Sørensen F, Finnerup NB, Cardenas DD, Defrin R, Lundeberg T, Norrbrink C, Richards JS, Siddall P, Stripling T, Treede R-D, Waxman SG, Widerström-Noga E, Yezierski RP, Dijkers M. International spinal cord injury pain classification: Part I. Background and description. Spinal Cord. 2012; 50(6): 413-417.
12. Nagoshi N, Kaneko S, Fujiyoshi K, Takemitsu M, Yagi M, Iizuka S, Miyake A, Hasegawa A, Machida M, Konomi T, Machida M, Asazuma T, Nakamura M. Characteristics of neuropathic pain and its relationship with quality of life in 72 patients with spinal cord injury. Spinal Cord. 2016; 54(9): 656-661.
13. Widerström-Noga E, Anderson KD, Perez S, Hunter JP, Martinez-Arizala A, Adcock JP, Escalona M. Living with chronic pain after spinal cord injury: A mixed-methods study. Arch Phys Med Rehabil. 2016 Nov 25. In print.
14. Tran J, Dorstyn DS, Burke ALJ. Psychosocial aspects of spinal cord injury pain: A meta-analysis. Spinal Cord. 2016; 54(9): 640-648.
15. Siddall PJ. Management of neuropathic pain following spinal cord injury: Now and in the future. Spinal Cord. 2009; 47(5): 352-359.
16. Widerström-Noga E, Turk DC. Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: Influence of pain and psychosocial characteristics. Spinal Cord. 2003; 41(11): 600–609.
17. Mehta S, Orenczuk K, McIntyre A, Willems G, Wolfe DL, Hsieh JTC, Short C, Loh E, Teasell RW, SCIRE Research Team. Neuropathic pain post spinal cord injury part 1: Systematic review of physical and behavioral treatment. Top Spinal Cord Inj Rehabil. 2013; 19(1): 61-77.
18. Guy SD, Mehta S, Casalino A, Côté I, Kras-Dupuis A, Moulin DE, Parrent AG, Potter P, Short C, Teasell R, Bradbury CL, Bryce TN, Craven BC, Finnerup NB, Harvey D, Hitzig SL, Lau B, Middleton JW, O'Connell C, Orenczuk S, Siddall PJ, Townson A, Truchon C, Widerström-Noga E, Wolfe D, Loh E. 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.
19. Norrbrink Budh C, Kowalski J, Lundeberg T. A comprehensive pain management pro­gramme comprising educational, cognitive and behavioural interventions for neuropathic pain following spinal cord injury. J Rehabil Med. 2006; 38(3): 172-180.
20. World Health Organization. International Classification of Diseases 11th revision (ICD-11) beta-browser. [Internet] Update February 2017. Available from: http://apps.who.int/classifications/icd11/browse/f/en. Accessed February 2017.
21. World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva, Switzerland: World Health Organization; 2001.
22. Jensen MP, Karoly P. Self-report scales and procedures for assessing pain in adults. In: Turk DC, Melzack R. (eds.) Handbook of pain assessment (Third edition). New York: The Guilford Press; 2001. p. 19-41.
23. Jensen MP, Stoelb BL, Molton IR. Measuring pain in persons with spinal cord injury. Top Spinal Cord Inj Rehabil. 2007; 13(2): 20–34.
24. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, Kerns RD, Stucki G, Allen RR, Bellamy N, Carr DB, Chandler J, Cowan P, Dionne R, Galer BS, Hertz S, Jadad AR, Kramer LD, Manning DC, Martin S, McCormick CG, McDermott MP, McGrath P, Quessy S, Rappaport BA, Robbins W, Robinson JP, Rothman M, Royal MA, Simon L, Stauffer JW, Stein W, Tollett J, Wernicke J, Witter J. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005; 113(1-2): 9-19.
25. Müller R, Gertz KJ, Molton IR, Terrill AL, Bombardier CH, Ehde DM, Jensen MP. Effects of a tailored positive psychology intervention on well-being and pain in individuals with chronic pain and a physical disability: A feasibility trial. Clin J Pain. 2016; 32(1): 32-44.
26. Müller R, Segerer W, Gemperli A, Stirnimann D, Hegi A, Geyh S, Jensen M. Inducing positive emotions in individuals with a spinal cord injury and chronic pain: The effects of positive psychology exercises. Oral presentation at the 55^th Annual Scientific Meeting of the International Spinal Cord Society (ISCoS) from 14-16 September 2016 in Vienna, Austria.

Download as PDF