EXPLORATION OF THE EXPERIENCES OF PERSONS IN THE TRAUMATIC SPINAL CORD INJURY POPULATION IN RELATION TO CHRONIC PAIN MANAGEMENT

T.-L. Williams¹, C. Joseph^2,3, L. Nilsson-Wikmar³, J. Phillips¹

¹University of The Western Cape, Physiotherapy, Cape Town, South Africa, ²Stellenbosh University, Division of Physiotherapy, Cape Town, South Africa, ³Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden

Background: Chronic pain amongst individuals with non-traumatic and traumatic spinal cord injury (TSCI) have high prevalence rates, with severe impact on activities of daily living, mood, sleep and quality of life.

Purpose: This study aimed to explore the experiences and challenges of chronic pain management amongst the traumatic spinal cord injury (TSCI) population, in the Western Cape region of South Africa.

Methods: A qualitative descriptive approach was chosen for the study. Purposive sampling, with maximum variation technique (with respect to gender, level of injury and type of pain) was used to recruit (13) persons. The inclusion criteria was restricted to adults who sustained a TSCI in the last five years (April 2016-April 2022) in the Cape Metropolitan region of the Western Cape. 84.6% of participants were male and 15.4% were female. The mean age of participants was 40.5 (standard deviation 10.6), with a four year mean of living with a TSCI (standard deviation 0.9). 100% of participants suffered from one type of chronic pain, 46.2% suffered from two types of chronic pains and 23.1% of participants suffered from three types of chronic pains. Below-level neuropathic pain (BL-NeuP) was the most common type of chronic pain. Musculoskeletal nociceptive pain (NP) was the second common chronic pain, occurring in three participants as their first pain as well as their second pain.

Results: The main theme which emerged was an overall discontentment and frustration with current pain management experienced by participants. The results indicate an ineffectiveness of standard pain management with a lack of education provided by healthcare professionals regarding pain physiology and pain management strategies. In addition, there is a lack of referral for alternative therapy in combination with pharmacological management. Unbalanced decision making was also found, with patients expressing the need to be heard by their healthcare professional. Patients resultingly developed coping strategies to survive with pain which consisted of cognitive and behavioral adaptations as well as relying on internal and external resources. Cognitive adaptations consisted of distraction and acceptance techniques. Behavioral adaptations consisted of movement. Internal and external resources referred to cultivating a positive mindset, practicing religious beliefs as well as relying on family support.

Conclusions: The current management of chronic pain in the TSCI population are sub-optimal at best. This study indicates the need for practices to move beyond pharmacological care, incorporating the principles of patient empowerment with knowledge and decision-making authority.

Implications: Advances in the field of chronic pain management should include a multidisciplinary approach, addressing biological processes, psychological status and sociocultural context outside of the specialized rehabilitation centers. In addition, improvements in current chronic pain management should be underpinned by the shared-decision making concept between clinician and patient.
Future research should conduct randomized controlled trials assessing acceptance and distraction techniques as interventions for chronic pain in the TSCI population.

Funding acknowledgements: This research received no external funding.

Keywords:
Chronic pain management
Traumatic spinal cord injury
Patient experiences

Topics:
Pain & pain management
Neurology: spinal cord injury

Did this work require ethics approval? Yes

Institution: University of The Western Cape

Committee: Biomedical research and ethics committee

Ethics number: BM20/8/22