Spinal Cord Injury Pain: The Influence of Psychologic Factors and Impact on Quality of Life

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.

Psychosocial factors in chronic spinal cord injury pain

(307) The Role of Fluctuations in Pain Acceptance, Coping, and Catastrophizing in the Daily Lives of People with Chronic Pain and Spinal Cord Injury

Pain and depression in acute traumatic spinal cord injury: Origins of chronic problematic pain?

Introduction: Pain following spinal cord injury (SCI) is notoriously difficult to manage and often refractory to treatment. Novel approaches, such as non-invasive brain stimulation, targeting central mechanisms associated with chronic pain, have shown early promise as a safe treatment in various patient groups, including spinal cord injury. To date the number of small clinical trials using non-invasive brain stimulation to treat chronic pain in SCI has produced mixed results. We report here the findings of a UK based trial examining the effects of anodal transcranial direct current stimulation (TdCs) administration on pain in spinal injury patients. Methods: Sixteen spinal injury patients from the National Spinal Injury Centre, Stoke Mandeville Hospital, Aylesbury, UK participated in a single centre, double blind randomized control trial. Patients were randomly allocated to either the active (n=8) or sham (n=8) treatment groups. tDCS was administered by electrodes with anode placement over the dominant M1 and the cathode electrode over the contralateral supraorbit scalp area. Subjects received either active (2 mA anodal current) or sham tDCS for 20 min daily treatment for 5 consecutive days with the dose based on previously reported chronic pain studies in spinal cord injury patients. A mixed ANOVA was used to evaluate both tDCS treatment and time effects on validated assessment measures for pain and depression up to 2 weeks following treatment intervention. Results: No adverse effects of the treatment were observed in this study, nor were there any significant differences between groups in rating perception of stimulation. While treatment appeared to have reduced group pain scores on a visual analogue scale [VAS], there were no statistically significant differences between active and sham treatment groups when re-examined in the 2 week follow up. Conclusion: There were some reductions in self-assessed VAS pain score in our small group of SCI patients during treatment in both the sham and active tDCS and at two weeks’ post treatment. However, our study appears to indicate only a placebo-like effect of tDCS on chronic pain in SCI, and not one attributed to the active, anodal stimulation over motor cortex. We also did not observe any significant effects over time or treatment for an assessment of neuropathic pain. We observed some trends of non-significant reduction in some of selfassessed pain scores measures, however, these are inconclusive. Studies of clinical efficacy of pain treatment by tDCS in spinal cord injury should therefore be conducted on a larger scale, and with a longer follow up period to address the limited evidence available.

Evaluation of an Interdisciplinary Program for Chronic Pain After Spinal Cord Injury

Exploring acute-to-chronic neuropathic pain in rats after contusion spinal cord injury

Spinal cord injury (SCI) can cause paralysis; sensory impairment; autonomic nervous system dysfunction; and bowel, bladder, and sexual dysfunction. These impairments may lead to immobility, physical dependence, and alterations in lifestyle and self-esteem. The addition of chronic, intractable pain to these impairments can be truly devastating. Chronic pain superimposed on spinal cord injury can virtually drain the individual of strength, motivation, and will. For the spinal cord injury survivor who already faces functional loss, severe pain can further restrict even the diversional activities that are available. Thus, it may become impossible for the individual to escape his or her pain even temporarily. The various medical, physical, and surgical treatments considered to be efficacious in treating this pain are reviewed. However, although chronic pain in SCI may be managed by these therapies, a permanent cure may not result.

Effects of intrathecal baclofen on chronic spinal cord injury pain

Pain Acceptance in People With Chronic Pain and Spinal Cord Injury: Daily Fluctuation and Impacts on Physical and Psychosocial Functioning

Developing a Model of Associations Between Chronic Pain, Depressive Mood, Chronic Fatigue, and Self-Efficacy in People With Spinal Cord Injury

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.
 AIM: To study the structure and features of pain syndrome in patients with spinal cord injury.
 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.
 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%.
 CONCLUSION: The most common and difficult to stop variant in the structure of pain syndrome in patients with spinal cord injury is neuropathic pain.

In a double blind study, 21 patients with chronic spinal cord injury (SCI) pain underwent placement of a lumbar subarachnoid catheter and injection of placebo and lidocaine. The effects on pain intensity, distribution, altered sensations and sensory level of anaesthesia were monitored. Four patients responded briefly to placebo, while 13 demonstrated a mean reduction of pain intensity of 37.8 +/- 37% for a mean duration of 123.1 +/- 95.3 minutes in response to lidocaine. The pain response to subarachnoid lidocaine differed significantly (p less than 0.01) from placebo. Spinal anaesthesia was also associated with changes in pain distribution and altered sensation. A spinal anaesthetic-induced sensory level could not be achieved cephalad to the sensory level of neurological injury in 5 patients who presented with spinal canal obstruction. This study has demonstrated that response to diagnostic spinal anaesthesia in chronic SCI pain is complex, requiring individual interpretation in each patient and consideration of the following factors; symptomatology, etiology, pain perception, spinal canal anatomy, CSF chemistry and local anaesthetic pharmacology.

BackgroundThe reported prevalence of chronic pain after spinal cord injury (SCI) varies widely due, in part, to differences in the taxonomy of chronic pain. A widely used classification system is...

Background: The role of brain imaging in the management of spinal cord injury (SCI)-related pain is still untapped but holds great promise. Objective: To provide a multidisciplinary framework for the use of various imaging techniques in SCI pain research and to describe changes in relevant brain structures implicated in the experience of pain. Method: A review of medical literature associated with acute and chronic pain, chronic SCI-related pain, relevant brain structures involved in the processing of pain, and various imaging techniques was performed using the PubMed database. Results: The present article provides a brief overview of the topic and is organized in the following manner: (1) introduction to chronic pain in SCI; (2) processing of pain; (3) common methods used for imaging of the brain in pain studies; (4) mechanisms of neuropathic pain; (5) role of specific brain areas based on research findings; (6) usefulness of imaging techniques in longitudinal studies and in clinical trials; and (7) conclusion. Conclusion: Brain imaging offers an opportunity to increase our understanding of the brain processes in persons with SCI and chronic pain and potentially generate new targets for therapeutic interventions.