19 | SCI And Chronic Pain Management

Managing Pain Day-to-Day

Discussion

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.

Post-SCI pain can appear at any time following a SCI and can develop into a chronic condition. In one study, approximately 34% of the study participants experienced pain immediately following the injury, and an additional 24% reported that the pain appeared within the first year post-injury. Among those suffering from pain, only 7% experienced a decrease of pain intensity and frequency over time, while 47% experienced an increase in pain over time. 7 In another study that included persons living with SCI and chronic pain, more than half of the study participants reported having pain for more than 5 years. 19

In Ida's case, she developed neuropathic pain three months after the SCI. It evolved into chronic pain that led to four inpatient rehabilitation stays over a course of 2 years. Ida's experience of pain limited her mobility (transferring and driving a car) and ability to carry out her daily routine. It also prevented Ida from returning to work, and negatively affected her emotional stability. In other words, chronic post-SCI pain impacted her quality of life tremendously.

"Ida's experience of decreased quality of life due to post-SCI pain is not isolated to her case."

Ida's experience of decreased quality of life due to post-SCI pain is not isolated to her case. Pain has shown to severely or completely interfere with the daily routine of persons with SCI and/or restrict a person's participation in major life areas, such as work and social life.1 3 5 7 12 13 14

"...it would be essential that the person develops strategies, including coping strategies, to effectively manage pain on a long-term basis."

To counter the negative impact of post-SCI Pain on a person's life, it would be essential that the person develops strategies, including coping strategies, to effectively manage pain on a long-term basis.{cs19-fin01} 3 7 13 14 In Ida's case, her lack of adaptive coping strategies coupled with depression and difficulty in handling stress, led to emotional instability and an exacerbation of pain.

"This multi-faceted approach to pain management is in line with the recommendations of many SCI experts, who support a comprehensive, multi-modal approach to managing pain following SCI."

Luckily, Ida was able to develop adaptive coping skills, improve her ability to handle stress, and stabilise her emotional status within a comprehensive, interdisciplinary inpatient rehabilitation programme for persons with SCI. Ida's rehabilitation plan was individualised to meet her pain management needs. Ida's rehabilitation and pain management programme applied a multi-modal approach that incorporated both pharmacological (e.g. optimisation of medication) and non-pharmacological interventions (e.g. psychological counselling, relaxation exercises, art and music therapy). Ida's rehabilitation team, specifically the psychologist on the team, also recognised the importance of involving the family in the rehabilitation and pain management process. For this reason, the psychologist also provided psychological counselling to Ida's husband and son, focusing on strengthening the communication between Ida, her husband, and son. This multi-faceted approach to pain management is in line with the recommendations of many SCI experts, who support a comprehensive, multi-modal approach to managing pain following SCI.1 3 16 17 18. Such a comprehensive pain management approach should also include education about post-SCI pain and possible treatments.1 3 13 18 19

A novel non-pharmacological approach to pain management that has been gaining attention in recent years is positive psychology. In one study of 77 persons with physical disability and chronic pain, including persons with SCI, Müller and colleagues found significant improvement in pain intensity and pain control after applying a computer-based positive psychology intervention.{cs19-fn25} A follow-up study investigating the feasibility, acceptability and efficacy of positive psychology interventions specifically for the SCI population is in progress.{cs19-fn26}

At the end of Ida's Rehab-Cycle®, she seemed more confident about being able to deal with her pain more effectively and was more hopeful about her life as a whole.

In conclusion, it is important to note that this comprehensive, interdisciplinary pain management approach worked well for Ida. However, since this case study concluded at Ida's discharge from the inpatient rehabilitation centre, it is unclear whether or how long her improvements were maintained in the community. There is a great need for further evidenced-based research on the effectiveness of such comprehensive, multi-modal, interdisciplinary approaches to managing post-SCI pain.

ICF Research Branch CoordinatorICF Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI)

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