Pain Management After Spinal Cord Injury Should Be Tailored to Pain Level, Subtype

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This study was part of a larger mixed-methods study that assessed facilitators and barriers to living with chronic pain after spinal cord injury.
This study was part of a larger mixed-methods study that assessed facilitators and barriers to living with chronic pain after spinal cord injury.

Pain management in patients with a spinal cord injury (SCI) should be tailored according to pain level and subtype, according to a study published in the Journal of Pain.

This study was part of a larger mixed-methods study that assessed facilitators and barriers to living with chronic pain after SCI. The study included individuals who had sustained an SCI, had been experiencing pain for ≥6 months, and had moderate to severe chronic pain (n=491). The researchers developed statements about these facilitators and barriers and asked study participants, during qualitative interviews, to quantify these statements using a Numeric Rating Scale (NRS) ranging from 0 (I do not agree) to 10 (I completely agree). An online quantitative survey was used to quantify interview results and identify overarching themes, which were defined by factor analysis.

From this analysis, 3 subgroups emerged: patients with High Pain Impact (HPI) (n=242), Moderate Pain Impact (MPI) (n=139), and Low Pain Impact (LPI) (n=102).

Participants in the HPI subgroup had severe pain with neuropathic pain characteristics. These participants used pain medication, multiple coping strategies, and self-remedies to manage pain. While they considered information about pain and pain management important, these participants were found to have difficulties communicating their pain adequately.

Participants in the MPI subgroup were able to function despite their pain and also considered information about pain and pain management important. Participants in the MPI subgroup used less medication compared with the HPI group due to concerns about adverse events and addiction.

Compared with the HPI and MPI subgroups, participants in the LPI subgroup considered information about pain, pain management, and communication about pain to be less important.

“Although the specific pain type and associated psychosocial comorbidities provide a rational basis for pain management, personal preferences and perspectives may provide additional tailoring options for patient-centered treatment strategies,” the researchers wrote.

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Reference

Widerstrom-Noga E, Anderson KD, Perez S, et al. Subgroup perspectives on chronic pain and its management after spinal cord injury [published online July 26, 2018]. J Pain. doi:10.1016/j.jpain.2018.07.003

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