Now showing 1 - 4 of 4
  • Publication
    Pain profiles in a community dwelling population following spinal cord injury: a national survey
    (Taylor & Francis, 2019-03-04) ; ;
    Context: While as many as 60% of patients with spinal cord injury (SCI) develop chronic pain, limited data currently exists on the prevalence and profile of pain post-SCI in community dwelling populations. Study Design: A cross-sectional population survey. Setting: Primary care. Participants: Community dwelling adults with SCI. Methods: Following ethical approval members registered to a national SCI database (n=1,574) were surveyed. The survey included demographic and SCI characteristics items, the International Spinal Cord Injury Pain Basic Data Set (version 1) the Douleur Neuropathique 4 questionnaire (interview) and questions relating to health care utilisation. Data were entered into the Statistical Package for the Social Sciences (version 20) Significance was set P < 0.05 for between group comparisons. Results: In total 643 (41%) surveys were returned with 458 (71%) respondents experiencing pain in the previous week. Neuropathic pain (NP) was indicated in 236 (37%) of responses and nociceptive pain in 206 (32%) Common treatments for pain included medications n=347 (76%) massage n=133 (29%) and heat n=115 (25%). Respondents with NP reported higher pain intensities and increased healthcare service utilisation (P= < 0.001) when compared to those with nociceptive pain presentations. A higher proportion of females than males reported pain (P = 0.003) and NP (P = 0.001) and those unemployed presented with greater NP profiles compared with those in education or employment (P = 0.006). Conclusion: Pain, in particular NP post SCI interferes with daily life, increases health service utilisation and remains refractory to current management strategies. Increased availability of multi-disciplinary pain management and further research into management strategies is warranted.
      242Scopus© Citations 16
  • Publication
    Quality of life after spinal cord injury: The impact of pain
    Pain is a common complication after spinal cord injury (SCI). A mixture of nociceptive and neuropathic pain (NP) can present. Limited studies have investigated the impact of different pain phenotypes on quality of life (QoL) post-SCI. Methods: Members registered to a national support group for those with SCIs were surveyed (n = 1574). The survey comprised questions relating to demographics and SCI characteristics, The Douleur Neuropathique 4 (DN4) (interview), the International SCI Pain Basic Data Set recording the worst pain and the World Health Organisation Quality of Life BREF (WHOQOL-BREF). An ANCOVA model with post hoc analysis explored between group factors of pain type and intensity of pain categories on QoL, controlling for additional confounding variables. Significance was set p < 0.05. A linear regression explored whether pain intensity, type or interference best predicted QoL. Results: The response rate was 41% (n = 643), 70% (n = 447) were male. The mean age of respondents was 52 years (SD 14.2) and mean time from SCI was 17 years (SD 12.4). In the previous week, 71% (n = 458) experienced pain, 37% (n = 236) of which had NP as defined in the study. Respondents experiencing NP demonstrated significantly poorer QoL than those without pain (p < 0.001) or nociceptive pain (p < 0.05). Those reporting high pain intensity had significantly lower QoL than those with moderate or no pain (p < 0.001). Pain interference consistently and best-predicted domains of QoL (p < 0.001). Conclusion: High-intensity pain and NP negatively impacts QoL post-SCI. However pain interference more than intensity or type best explains the variance in QoL reported. Significance: Neuropathic pain type and severe pain intensities negatively impact QoL after SCI. Pain interference items better predict reported QoL than either pain type or intensity, suggesting better pain management strategies are warranted.
      919Scopus© Citations 51
  • Publication
    Neuropathic pain prevalence following spinal cord injury: A systematic review and meta-analysis
    Following spinal cord injury (SCI), chronic pain is a common secondary complication with neuropathic pain (NP) cited as one of the most distressing and debilitating conditions leading to poor quality of life, depression and sleep disturbances. Neuropathic pain presenting at or below the level of injury is largely refractory to current pharmacological and physical treatments. No consensus on the prevalence of NP post SCI currently exists, hence this systematic review was undertaken. The review comprised three phases: a methodological assessment of databases [PubMed, Embase, Web of Knowledge, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library and Physiotherapy Evidence Database (PEDro)] identifying potential papers and screening for inclusion criteria by two independent reviewers; data extraction; and finally rating of internal validity and strength of the evidence, using a published valid and reliable scale. Meta‐analysis estimated pooled point prevalence rates using a random effects model. In total, 17 studies involving 2529 patients were included in the review. Overall point prevalence rates for NP were established at 53% (38.58–67.47); 19% (13.26–26.39) for at‐level NP and 27% (19.89–34.61) for below‐level NP, with high heterogeneity noted (I2 = 84–93%). Prevalence rates for NP following SCI are high. Future studies should include established definitions, classification systems and assessment tools for NP at defined time points post SCI to follow the trajectory of this problem across the lifespan and include indices of sleep, mood and interference to allow for appropriate, optimal and timely NP management for each patient.
      516Scopus© Citations 245
  • Publication
    An internet-delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: A randomized controlled trial
    Background: Chronic pain is common after spinal cord injury (SCI) and dedicated SCI cognitive behavioural therapy pain management programmes (CBT-PMPs) have a growing evidence base to support their uptake clinically. The development of internet-delivered treatment options may overcome barriers to the access and uptake of centre-based programmes. This study examines such an approach on quality of lie (QoL), pain, mood and sleep. Methods: Adults with SCI pain (>3 months) were recruited and randomly assigned to the intervention or control group. The intervention comprised a six module CBT-PMP delivered once weekly. A blinded assessor determined changes in self-reported outcome measures post-intervention and at 3 months. Linear mixed models and effect sizes based on changes between groups were reported. Significance was set p < 0.05. Results: The recruitment rate was 32% (intervention n = 35, control n = 34), and the drop-out rate at 3 months was 26%. On average, participants accessed three (SD 2.1) of six modules. While no difference in QoL was reported, a significant group*time interaction was found for NRS of current pain (χ2 = 8.22, p = 0.016), worst pain (χ2 = 11.20, p = 0.004), and Brief Pain Inventory (interference) (χ2 = 6.924, p = 0.031). Moderate to large effect sizes favouring the intervention were demonstrated at each time point for the pain metrics (Cohen's d: 0.38–0.84). At 3-month follow-up, 48% of the intervention group rated themselves improved or very much improved (p < 0.05). Conclusions: This study demonstrates the potential of an internet-delivered SCI specific CBT-PMP in reporting significant statistical and clinical benefit in pain intensity and interference. Strategies to improve engagement are needed.
      480Scopus© Citations 22