Abstract
BackgroundMost people with a spinal cord injury rate neuropathic pain as one of the most difficult problems to manage and there are no medical treatments that provide satisfactory pain relief in most people. Furthermore, psychosocial factors have been considered in the maintenance and aggravation of neuropathic spinal cord injury pain. Psychological interventions to support people with spinal cord injury to deal with neuropathic pain, however, are sparse. The primary aim of the CONECSI (COping with NEuropathiC Spinal cord Injury pain) trial is to evaluate the effects of a multidisciplinary cognitive behavioural treatment programme on pain intensity and pain-related disability, and secondary on mood, participation in activities, and life satisfaction.Methods/DesignCONECSI is a multicentre randomised controlled trial. A sample of 60 persons with chronic neuropathic spinal cord injury pain will be recruited from four rehabilitation centres and randomised to an intervention group or a waiting list control group. The control group will be invited for the programme six months after the intervention group. Main inclusion criteria are: having chronic (> 6 months) neuropathic spinal cord injury pain as the worst pain complaint and rating the pain intensity in the last week as 40 or more on a 0-100 scale. The intervention consists of educational, cognitive, and behavioural elements and encompasses 11 sessions over a 3-month period. Each meeting will be supervised by a local psychologist and physical therapist. Measurements will be perfomed before starting the programme/entering the control group, and at 3, 6, 9, and 12 months. Primary outcomes are pain intensity and pain-related disability (Chronic Pain Grade questionnaire). Secondary outcomes are mood (Hospital Anxiety and Depression Scale), participation in activities (Utrecht Activities List), and life satisfaction (Life Satisfaction Questionnaire). Pain coping and pain cognitions will be assessed with three questionnaires (Coping Strategy Questionnaire, Pain Coping Inventory, and Pain Cognition List).DiscussionThe CONECSI trial will reveal the effects of a multidisciplinary cognitive behavioural programme for people with chronic neuropathic spinal cord injury pain. This intervention is expected to contribute to the rehabilitation treatment possibilities for this population.Trial RegistrationDutch Trial Register NTR1580.
Highlights
Most people with a spinal cord injury rate neuropathic pain as one of the most difficult problems to manage and there are no medical treatments that provide satisfactory pain relief in most people
The CONECSI trial will reveal the effects of a multidisciplinary cognitive behavioural programme for people with chronic neuropathic spinal cord injury pain
People with spinal cord injury (SCI) consistently rate chronic SCI pain (CSCIP) as one of the most difficult problems to manage, despite the presence of other problems that interfere with daily life [2], and it is a major impediment to effective rehabilitation [3]
Summary
This multidisciplinary cognitive behavioural programme for coping with CNSCIP will be evaluated in a multicentre trial, in which 60 persons will be randomised to an intervention group or a waiting list control group in four participating rehabilitation centres. The CONECSI trial meets the need for an RCT for the evaluation of CBT for people with CNSCIP, focusing on reduction of negative pain cognitions and promoting adaptive coping This intervention is expected to contribute to the treatment options for people with CNSCIP, a severe problem for which existing treatments are insufficiently effective. We use a pain-related disability score and not a generic disability measure to minimize the influence of the paralysis and other secondary conditions of the disability on outcomes of this trial If this new intervention turns out to be effective, its chances on implementation in the rehabilitation setting in the Netherlands are good. A table with the 11 sessions of the programme and a summary of the main content of each session
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