To create holistic management principles comprising pharmacological and non-pharmacological interventions for chronic pain in the TSCI population in South Africa. To create holistic management principles comprising pharmacological and non-pharmacological interventions for chronic pain in the TSCI population in South Africa.
The Intervention mapping framework (IMF) was used to guide the creation of management principles. Step one consisted of a needs analysis, through a quantitative study, amongst persons with TSCI (PWTSCI) focusing on their chronic pain and its management. Step two involved determining the required matrices of change in relation to the assessment and management of chronic pain from the perspectives of PWTSCI as well as healthcare providers. In step three of the IMF, the current global guidelines for chronic pain management was sought through a scoping review. Lastly, step four comprised of consensus reaching on the feasibility and contextual relevance of principles for the management of chronic pain amongst PWTSCI at primary healthcare level in a low-resourced context.
The needs analysis revealed the burden of chronic pain and its negative influence on mental health. In addition, the specific sub-types of pain prevalent in this population were identified (below-level neuropathic pain and nociceptive pain). The matrices of change identified from PWTSCI included the need for non-pharmacological interventions for chronic pain management and the need for an improved healthcare provider-patient relationship. From the healthcare providers perspective, the matrices of change were multi-fold. There was a need for the assessment and management of mental health and substance abuse amongst patients, the need for patient-centred and holistic approaches to pain management, the need for guidelines as well as improved knowledge and expertise amongst healthcare providers. The scoping review identified German guidelines for chronic pain in the SCI population. These guidelines were appraised with the AGREEII tool and rated as high-quality. Lastly, the Delphi study resulted in the inclusion of 18 principles (formulated from step one to three of the IMF) through consensus reaching to guide the management of chronic pain in PWTSCI. The principles are distributed into three categories: 1. Assessment, education and planning in relation to chronic pain and its management, 2. Pharmacological management of neuropathic and nociceptive pain, 3. Non-pharmacological management of neuropathic and nociceptive pain, and 4. Monitoring of chronic pain and referral of resistant chronic pain.
Using the IMF was useful and successful in creating initial design principles for improved pain management in PWTSCI. These principles will require an overhaul of existing systems and processes at various levels of management and leadership.
Assessment of the implementation of these principles should occur, to identify challenges and facilitators.
traumatic spinal cord injury
management principles
