Pain - either neuropathic or nociceptive – is highly prevalent in spinal cord injury cases during and/or following rehabilitation, and may even occur or recur years following the time of injury. Pain can greatly compromise quality of life, lead to decreased body functioning, reduce an individual’s capacity to perform activities and overall result in low or reduced participation. Oftentimes, a first line approach to therapy is based upon pharmaceuticals such as analgesics and anti-inflammatory agents.
However, this therapeutic path does not always result in quality-of-life gains. In Ida’s case, the drug-based approach that had been utilized when she was hospitalized three times for pain management had not been effective, failing to reduce her pain (in one instance even increasing her pain) or improve mobility and quality of life. Although she maintained independence in daily living, her constant pain led to reductions in both her range of activities and her ability to participate.
This interdisciplinary rehabilitation approach that included a range of non-pharmacological interventions helped her make strides towards greater pain management, as well as decreases in her pain overall. Here, the primary cycle goal focused on stress reduction and the development of longer term coping strategies.
The multidisciplinary and comprehensive approach undertaken proved effective for Ida. Her last pain management programs focused primarily on medication and other intervention strategies only completed her therapeutic schedule. This time all interventions were synchronized and deliberately planned as a comprehensive program.
Her sleep and mobility improved. Gains were achieved for her overall mobility. Her perceived pain improved as demonstrated by her decreased VAS score. And importantly, through a range of inter-disciplinary interventions Ida was able to identify and develop a coping strategy that integrated a variety of interventions that could be maintained as long as necessary beyond the Rehab Cycle. Music and art therapy, mobility exercises including hippotherapy and sports therapy all proved beneficial. Drugs such as Lidocaine that were found to not be contributing to improvements were phased out.
Family counseling focused on strengthening communication and supporting Ida’s willingness to be cared for, both critical for reducing the stress of daily living. The sum of both the rehabilitative interventions and those that could be continued at home - like the hippo- and arts therapy - and her participation in the day clinic program provided Ida with both a sense of control and a framework for managing her pain from day-to-day. This was a key element and starting point from which Ida could improve her participation in life, and the quality of her lived experience.
In conclusion, it is important to stress that this time the comprehensive and interdisciplinary pain management approach worked very well for Ida but unfortunately there is never the guarantee that the improvements will last in the long term future. However it should be noted that only very few studies have assessed the effectiveness of such comprehensive and multi-disciplinary approaches and there is a need for further research.