Hypnotic Cognitive Therapy for Chronic Pain in Spinal Cord Injury: A Randomized Controlled Trial.

Context/Objective In-person hypnotic cognitive therapy (HYP-CT) is a promising treatment for chronic spinal cord injury-related pain. We describe the effects of HYP-CT delivered via Zoom (Z-HYP-CT) and compare the effects to historical controls who received hypnosis, cognitive therapy, or HYP-CT in-person. Design Open pilot trial of HYP-CT versus historical controls. Setting Telehealth study that recruited people with chronic SCI. Participants Adults with moderate to severe chronic SCI-related pain. Interventions Four weekly sessions of HYP-CT delivered via Zoom. Outcome measures The primary outcome was average pain intensity on a 0–10 numerical rating scale measured at end of treatment (4 weeks) and 12 weeks. Secondary outcomes included pain interference, depression, sleep, pain catastrophizing, and pain self-efficacy. Results 23 individuals with SCI-related pain participated in the open trial and were compared to 21 historical controls. Average age was 54 years, 70% were male, and the majority were White. The participants were 11.6-13.1 years post-SCI and average pain intensity was 4.8-5.4/10. After Z-HYP-CT mixed-effects linear regressions showed that pain intensity was significantly less at 4 weeks (−1.28, P < .0001) and 12 weeks (−1.50, P < .0001) relative to baseline. Pain interference, depression, and pain catastrophizing also decreased significantly at both time points. There were no significant differences between the effects of Z-HYP-CT versus historical controls on any outcome variable. Conclusion HYP-CT delivered via telehealth was associated with reduced pain intensity and other benefits that were comparable to the effect achieved by in-person historical controls. The effects of Z-HYP-CT should be evaluated using a randomized controlled design.

Efficacy of amitriptyline for relief of pain in spinal cord injury: results of a randomized controlled trial

Introduction. Pain perception varies due to many factors. Quantitative sensory testing is a panel of diagnostic tests used to assess somatosensory function. The aim of the study was to determine how psychophysical variables are related to the perceived pain intensity in patients with chronic pain. Material and Methods. The cross-sectional study included 88 subjects (average age 51.3 ? 9.4 years, 76 (86.4%) women) diagnosed with chronic pain syndrome and fibromyalgia or chronic neuropathic pain associated with lumbosacral radiculopathy. Current and average pain intensities in the past 4 weeks were rated on a numerical rating scale. Quantitative sensory testing included pressure pain thresholds, heat pain thresholds, and cold pain thresholds. Patients filled out the Fear Avoidance Component Scale, a questionnaire that examines the fear avoidance phenomenon. Results. The highest correlations were found between the Fear Avoidance Component Scale scores and current and average pain intensity (r = 0.438 and r = 0.253, respectively); between pain duration and current and average pain intensity in the past 4 weeks (r = 0.340 and r = 0.308, respectively). Moderate and negative correlations were found between pressure pain thresholds and current and average pain intensity (r = - 0.233 and r = -0.300, respectively). Conclusion. Low to moderate, significant positive correlations were found between fear-avoidance and pain intensity. Significant but low negative correlations were found between pressure pain threshold and current pain intensity, as well as between pressure pain threshold and average pain intensity.

To examine chronic pain prevalence in a spinal cord injury (SCI) population, and to determine the influence of psychologic factors on SCI pain and impact of SCI pain on quality of life. Five hundred seventy-five persons with SCI were asked to participate in the study. Demographic, SCI, and pain characteristics were obtained. The Chronic Pain Grade, anger items of the Profile of Mood States, Illness Cognition Questionnaire, Pain Coping and Cognition List, and Patient Health Questionnaire were used. General health and well-being were assessed with 0-10 scales. The influence of psychologic factors was assessed with regression analyses controlling for person and injury characteristics and pain intensity. Response rate was 49%. SCI pain prevalence was high (77.1%). More internal pain control and coping, less catastrophizing, higher level of lesion, and nontraumatic SCI cause were associated with less pain intensity. More pain was associated with higher pain-related disability. Lower catastrophizing was related to better health. Less SCI helplessness and catastrophizing, greater SCI acceptance and lower anger levels were related to higher well-being. Higher levels of SCI helplessness, catastrophizing, and anger were related to higher depression levels. Pain intensity showed no independent relationships with health, well-being, and depression in the regression analyses. Chronic SCI pain and quality of life were both largely associated with several psychologic factors of which pain catastrophizing and SCI helplessness were most important. Psychologic intervention programs may be useful for persons suffering from chronic SCI pain to improve their quality of life.

The purpose of this study was to define the relationships among clinical characteristics of chronic pain, injury characteristics, affective factors and autonomic dysreflexia (AD) in people with chronic cervical spinal cord injury (SCI). A survey containing questions concerning the presence of AD, demographic factors, clinical characteristics of pain and affective symptoms, was mailed to people with traumatic SCI and chronic pain included in the Miami Project to Cure Paralysis database. Of all subjects (n = 330) reporting chronic pain in a previous study, 181 had cervical injuries. Of this subset, 117 (64.6%) participated in the study. Thirty-five people (29.9%) reported AD in our study. Although intense pain has previously been reported to trigger AD, the average pain intensity was not predictive of AD. Pair-wise comparisons indicated that people reporting AD marked significantly more painful areas in the drawing and used more descriptive pain adjectives. Anxiety and sadness were significantly more frequent among people with AD. Furthermore, aggravation of pain due to muscle spasms, infections, full bladder, and constipation was significantly more common among people with AD. The logistic regression analysis indicated that a combination of having widespread pain, experiencing aggravation of pain due to infections, having a complete injury, and experiencing anxiety significantly predicted AD. Our results suggest that relationships between chronic pain and AD exist. Since multiple pain types are common after SCI and may be associated with AD, it is important to determine which pain types that may be particularly important for the condition of AD.

Pain and Its Impact on Inpatient Rehabilitation for Acute Traumatic Spinal Cord Injury: Analysis of Observational Data Collected in the SCIRehab Study

Hypnosis Enhances the Effects of Pain Education in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial

BackgroundChronic low back pain (LBP) and neck pain (NP) are highly prevalent conditions resulting in high economic costs. Treatment guidelines recommend relaxation techniques, such as progressive muscle relaxation, as adjuvant therapies. Self-care interventions could have the potential to reduce costs in the health care system, but their effectiveness, especially in a usual care setting, is unclear. The aim of these two pragmatic randomized studies is to evaluate whether an additional app-delivered relaxation is more effective in the reduction of chronic LBP or NP than usual care alone.Methods/designEach pragmatic randomized two-armed study aims to include a total of 220 patients aged 18 to 65 years with chronic (>12 weeks) LBP or NP and an average pain intensity of ≥ 4 on a numeric rating scale (NRS) in the 7 days before recruitment. The participants will be randomized into an intervention and a usual care group. The intervention group will be instructed to practice one of these 3 relaxation techniques on at least 5 days/week for 15 minutes/day over a period of 6 months starting on the day of randomization: autogenic training, mindfulness meditation, or guided imagery. Instructions and exercises will be provided using a smartphone app, baseline information will be collected using paper and pencil. Follow-up information (daily, weekly, and after 3 and 6 months) will be collected using electronic diaries and questionnaires included in the app.The primary outcome measure will be the mean LBP or NP intensity during the first 3 months of intervention based on daily pain intensity measurements on a NRS (0 = no pain, 10 = worst possible pain). The secondary outcome parameters will include the mean pain intensity during the first 6 months after randomization based on daily measurements, the mean pain intensity measured weekly as the average pain intensity of the previous 7 days over 3 and 6 months, pain acceptance, ‘LBP- and NP-related’ stress, sick leave days, pain medication intake, adherence, suspected adverse reaction, and serious adverse events.DiscussionThe designed studies reflect a usual self-care setting and will provide evidence on a pragmatic self-care intervention that is easy to combine with care provided by medical professionals.Trial registrationClinicalTrials.gov identifier Relaxback NCT02019498, Relaxneck NCT02019134 registered on 18 December 2013.

The thermal grill illusion of pain (TGIP) is a paradoxical burning pain sensation elicited by the simultaneous application of innocuous cutaneous warm and cold stimuli with a thermode ("thermal grill") consisting of interlaced heated and cooled bars. Its neurophysiological mechanisms are unclear, but TGIP may have some mechanisms in common with pathological pain, including central sensitization in particular, through the involvement of N-methyl- d -aspartate receptors. However, few studies have investigated TGIP in patients with chronic pain and its clinical relevance is uncertain. We hypothesized that the TGIP would be increased in comparison with controls in patients with fibromyalgia or irritable bowel syndrome, which are regarded as typical "nociplastic" primary pain syndromes related to changes in central pain processing. We compared the sensations elicited by a large range of combinations of temperature differentials between the warm and cold bars of a thermal grill applied to the hand between patients with fibromyalgia (n = 30) or irritable bowel syndrome (n= 30) and controls (n = 30). The percentage of TGIP responses and the intensity and unpleasantness of TGIP were significantly greater in patients than controls. Furthermore, positive correlations were found between TGIP intensity and clinical pain intensity and between TGIP intensity and the cold pain threshold measured on the hand. These results are consistent with our working hypothesis of shared mechanisms between TGIP and clinical pain mechanisms in patients with nociplastic chronic pain syndromes and suggest that TGIP might represent a clinical marker of central sensitization in these patients.

Cross-sectional survey. To estimate the prevalence, predictors and impact of self-reported pain and spasticity and examine variables affecting quality of life in individuals with a traumatic spinal cord injury (SCI). Nationwide, Denmark. An anonymous questionnaire was sent out to individuals with a traumatic SCI. The questionnaire included questions about demographics and SCI characteristics, pain, spasticity and quality of life. In total, 537 questionnaires were completed. Seventy-three percent reported chronic pain of which 60% used descriptors suggestive of neuropathic pain. The average pain intensity and interference were 5.6 (s.d. 2.3) and 5.0 (s.d. 2.8), respectively, on a 0-10 numeric rating scale (NRS), and 28.1% reported severe pain. Seventy-one percent reported spasticity. Average interference of spasticity was 2.9 (s.d. 2.7). Quality of life scores were 6.5 (s.d. 2.5) for life and life situation, 5.5 (s.d. 2.6) for physical health and 6.7 (s.d. 2.6) for mental health on the NRS (0-10). Female gender was associated with lower mental health scores and tetraplegia with lower physical health scores, and high pain interference and shorter time since injury were associated with lower quality-of-life scores for all three parameters. Pain with descriptors suggestive of neuropathic pain was associated with lower quality-of-life scores than pain without such descriptors. Chronic pain and spasticity are common problems after SCI, and in particular, high pain interference is associated with lower quality of life.

Cancer pain intensity (PI) fluctuates, but the relationship between pain flares and background pain with respect to pain management is not settled. We studied how flare and background PIs corresponded with treatment results for background cancer pain. Patients admitted to an acute palliative care unit with average and/or worst PI ≥ 1 on the 11-point numeric rating scale were included. Average and worst PI at admission and average PI at discharge were collected. We examined how the difference and ratio between worst and average PI and average PI at admission, were associated with average PI development during hospitalization. Positive differences between worst and average PI at admission were defined as pain flares. Ninety out of 131 patients had pain flares. The reduction in average PI for patients with flares was 0.9 and for those without, 1.9 (p = 0.02). Patients with large worst minus average PI differences reported the least improvement, as did those with large worst/average PI ratios. Patients with pain flares and average PI ≤ 4 at admission had unchanged average PI during hospitalization, while those with pain flares and average PI > 4 experienced pain reduction (2.1, p < 0.001). Large pain flares, in absolute values and compared to background PI, were associated with inferior pain relief.

Pain Interference in Persons With Spinal Cord Injury: Classification of Mild, Moderate, and Severe Pain

Chronic neuropathic pain (CNP) in spinal cord injury (SCI) is recognized as severely compromising, in both adjustment after injury and quality of life. Studies indicate that chronic pain in SCI is associated with great emotional distress over and above that of the injury itself. Currently, little is known about the SCI patient's perception of the impact of living with chronic neuropathic pain. The purpose of this study was to explore the experience of CNP in SCI patients in relation with physical, emotional, psychosocial, environmental, informational, practical and spiritual domains, and to identify effective and ineffective pain coping strategies. Three focus groups were conducted that included 24 SCI individuals living in the community. Participants were selected to maximize variation in terms of type of SCI, Frankel classification, years since onset of SCI, age and sex. The sessions were audiotaped and tapes were transcribed. A qualitative analysis of data involved a constant comparison approach, in which categories and themes were identified. Many complex themes emerged including: nature of pain; coping as process and product; medication failure; and the impact of CNP on physical, cognitive, emotional, interpersonal, social and life activities. Medication failure was identified as a common outcome, while strategies including use of warm water, swimming, increased activity and distraction provided temporary pain relief. Learning to live with the pain appeared to be related to acceptance of pain, which in turn seemed to facilitate adjustment. Further research is warranted to determine the process by which SCI patients learn to live with CNP and coping strategies that facilitate adjustment to CNP in SCI patients.

Postal survey. To examine if the intensity of pain in persons with spinal cord injury (SCI) varied as a function of pain site, and to identify the patient and SCI characteristics associated with pain location, pain intensity and pain interference in a sample of persons with SCI. Community sample, United States. A postal survey including measures of pain intensity, pain interference, other pain, demographic and medical characteristics was completed by 238 adults with SCI. Average pain intensity was moderate and pain was common across the body. Demographic and medical variables, including SCI level, were generally not associated with pain prevalence, intensity and interference. However, persons with higher level injuries were more likely to report upper extremity pain than persons with paraplegic injuries. The lower body was the location of the highest pain ratings. Persons with SCI tend to experience high pain intensity over multiple body locations. Lower body pain was as common as upper extremity pain, but tended to be more intense.

BACKGROUND: The original Pain syndrome in spinal cord injury, which by its nature is one of the most severe and debilitating conditions, can lead to a deterioration in the quality of life, depression, sleep disorders and, as a consequence, a decrease in the results of rehabilitation treatment. This article will present epidemiological data of pain syndrome in spinal cord injury.&#x0D; AIM: To study the structure and features of pain syndrome in patients with spinal cord injury.&#x0D; MATERIALS AND METHODS: The clinical data on a sample of patients with pain syndrome in spinal cord injury are analyzed (n = 75). The study group was represented by male patients (100%), whose average age was 36 years, undergoing inpatient treatment on the basis of the National Medical Research Center for High Medical Technologies — A.A. Vishnevsky Central Military Clinical Hospital, Ministry of Defense, Russia. The analysis of pain syndrome in this cohort was carried out on 8 indicators at once: neurological level of injury, localization of pain, intensity of pain, motor neurological deficit, degree of damage to the anatomical integrity of the spinal cord, the presence of a neuropathic component, the type of pain syndrome and characteristic pain descriptors.&#x0D; RESULTS: According to the classification of pain in spinal cord injury, proposed by an international consensus of clinicians and researchers, the prevalence of various types of pain among the study group was presented as follows: neuropathic — 64%, nociceptive — 32, dysfunctional — 4%. Analyzing various subtypes of neuropathic pain, pain below the injury level dominated — 72%.&#x0D; CONCLUSION: The most common and difficult to stop variant in the structure of pain syndrome in patients with spinal cord injury is neuropathic pain.