Abstract
Study design
Single-subject repeated measures design.
Objectives
To explore the impacts of a novel individualized interdisciplinary pain self-management program for persons living with spinal cord injury pain.
Setting
A large rehabilitation institute for adults with physical disabilities in Quebec city (Quebec, Canada).
Methods
Six persons having sustained a spinal cord injury and experiencing chronic pain participated. Following a five-week pre-intervention phase (baseline repeated measures) and a clinical evaluation, individualized intervention objectives were developed in collaboration with each participant. Then, participants completed a ten-week intensive intervention and a six-month consolidation phase. The program included cognitive behavioral therapy, and physical and pharmacological interventions, which were group- and individual-based. Outcome measures were the Canadian Occupational Performance Measure (COPM), the French-Canadian Chronic Pain Self-efficacy Scale (FC-CPSES), the Brief Pain Inventory (BPI), and the Hospital Anxiety and Depression Scale (HADS).
Results
For five out of the six participants, a majority of outcomes improved during either of the intervention phases or both. Improvements in occupational performance were clinically significant for three participants. Pain interference and anxiety improved significantly in five participants, while pain self-efficacy and depressive symptoms improved in four participants.
Conclusions
The results suggest that the pain self-management program was effective to reduce the impact of spinal cord injury pain. Further research is needed to replicate these results in a larger study and comprehend the factors favoring or undermining improvements with such programs, as well as their persistence over time.
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Data availability
The datasets generated and analyzed during the current study could be made available from the corresponding author on reasonable request.
References
van Gorp S, Kessels AG, Joosten EA, van Kleef M, Patijn J. Pain prevalence and its determinants after spinal cord injury: a systematic review. Eur J Pain. 2015;19:5–14.
Mehta S, Teasell RW, Loh E, Short C, Wolfe DL, Benton B, et al. Pain following spinal cord injury. In: Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, et al. (eds). Spinal Cord Injury Rehabilitation Evidence. Version 7.0. 2019. pp. 1–105.
Tran J, Dorstyn DS, Burke AL. Psychosocial aspects of spinal cord injury pain: a meta-analysis. Spinal Cord. 2016;54:640–8.
Burns AS, Delparte JJ, Ballantyne EC, Boschen KA. Evaluation of an interdisciplinary program for chronic pain after spinal cord injury. PM R 2013;5:832–8.
Heutink M, Post MW, Luthart P, Pfennings LE, Dijkstra CA, Lindeman E. A multidisciplinary cognitive behavioural programme for coping with chronic neuropathic pain following spinal cord injury: the protocol of the CONECSI trial. BMC Neurol [Internet]. 2010;10:96.
Heutink M, Post MW, Bongers-Janssen HM, Dijkstra CA, Snoek GJ, Spijkerman DC, et al. The CONECSI trial: Results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury. Pain 2012;153:120–8.
Heutink M, Post MW, Luthart P, Schuitemaker M, Slangen S, Sweers J, et al. Long-term outcomes of a multidisciplinary cognitive behavioural programme for coping with chronic neuropathic spinal cord injury pain. J Rehabil Med. 2014;46:540–5.
Nicholson Perry K, Nicholas MK, Middleton JW. Comparison of a pain management program with usual care in a pain management center for people with spinal cord injury-related chronic pain. Clin J Pain. 2010;26:206–16.
Dear BF, Nicholson Perry K, Siddall P, Middleton JW, Johnson J, Katte L, et al. The Pain Course: Exploring the feasibility of an internet-delivered pain management programme for adults with spinal cord injury. Spinal Cord. 2018;56:931–9.
Dear BF, Titov N, Perry KN, Johnston L, Wootton BM, Terides MD, et al. The Pain Course: a randomised controlled trial of a clinician-guided Internet-delivered cognitive behaviour therapy program for managing chronic pain and emotional well-being. Pain 2013;154:942–50.
Norrbrink Budh C, Kowalski J, Lundeberg T. A comprehensive pain management programme comprising educational, cognitive and behavioural interventions for neuropathic pain following spinal cord injury. J Rehabil Med. 2006;38:172–80.
Flor H, Turk DC. Chronic pain: an integrated biobehavioral approach. IASP Press, Seattle; 2011.
Norrbrink C, Lofgren M. Needs and requests - patients and physicians voices about improving the management of spinal cord injury neuropathic pain. Disabil Rehabil. 2016;38:151–8.
Portney LG. Foundations of clinical research: applications to evidence-based practice. Fourth ed. F.A. Davis Company, Philadelphia; 2020.
Quirion R. Développement d’un programme d’autogestion de la douleur chronique pour les personnes vivant avec une lésion médullaire [master’s essay]. Université de Sherbrooke, Sherbrooke; 2014.
Taylor SJC, Carnes D, Homer K, Pincus T, Kahan BC, Hounsome N, et al. Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS). NIHR Journals Library, Southampton; 2016.
Law M, Baptiste S, Carswell A, McColl MA, Polatajko H, Pollock N. La mesure canadienne du rendement occupationnel. Fifth ed. CAOT Publications ACE, Ottawa; 2014.
Carpenter L, Baker GA, Tyldesley B. The use of the Canadian Occupational Performance Measure as an outcome of a pain management program. Can J Occup Ther. 2001;68:16–22.
Bryce TN, Budh CN, Cardenas DD, Dijkers M, Felix ER, Finnerup NB, et al. Pain after spinal cord injury: an evidence-based review for clinical practice and research. Report of the National Institute on Disability and Rehabilitation Research Spinal Cord Injury Measures meeting. J Spinal Cord Med. 2007;30:421–40.
Raichle KA, Osborne TL, Jensen MP, Cardenas D. The reliability and validity of pain interference measures in persons with spinal cord injury. J Pain. 2006;7:179–86.
Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 1995;61:277–84.
Poundja J, Fikretoglu D, Guay S, Brunet A. Validation of the French version of the Brief Pain Inventory in Canadian veterans suffering from traumatic stress. J Pain Symptom Manag. 2007;33:720–6.
Lacasse A, Bourgault P, Tousignant-Laflamme Y, Courtemanche-Harel R, Choiniere M. Development and validation of the French-Canadian Chronic Pain Self-efficacy Scale. Pain Res Manag. 2015;20:75–83.
Savard J, Laberge B, Gauthier JG, Ivers H, Bergeron MG. Evaluating anxiety and depression in HIV-infected patients. J Pers Assess. 1998;71:349–67.
Woolrich RA, Kennedy P, Tasiemski T. A preliminary psychometric evaluation of the Hospital Anxiety and Depression Scale (HADS) in 963 people living with a spinal cord injury. Psychol Health Med. 2006;11:80–90.
Muller R, Cieza A, Geyh S. Rasch analysis of the Hospital Anxiety and Depression Scale in spinal cord injury. Rehabil Psychol. 2012;57:214–23.
Noreau L, Proulx P, Gagnon L, Drolet M, Laramee MT. Secondary impairments after spinal cord injury: a population-based study. Am J Phys Med Rehabil. 2000;79:526–35.
Acknowledgements
The authors wish to thank all the stakeholders involved in the pain self-management program studied (managers, professionals and users), as well as Chantal Dufour for her help with documentary research.
Funding
This work was supported by funds granted to KPe by the Fonds de recherche du Québec – Santé, through her Junior 1 Research Scholar grant; and start-up funds from the Centre interdisciplinaire de recherche en réadaptation et intégration sociale.
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MEL and RQ initiated and designed the study. The protocol was drafted by MEL, RQ, ID, KPe, and CM. Data were collected by RQ, ID and KPe. KPr and KPe analysed and interpreted the data. The manuscript was drafted by KPr and KPe. All authors critically revised the manuscript and they have accepted responsibility for its entire content and approved its submission.
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Proulx, K., Lamontagne, ME., Quirion, R. et al. A six-participant pilot single-subject study of an individualized pain management program for people with spinal cord injury. Spinal Cord Ser Cases 9, 2 (2023). https://doi.org/10.1038/s41394-022-00557-z
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DOI: https://doi.org/10.1038/s41394-022-00557-z
