Patients' perspectives on pain

Abstract

Nociceptive and neuropathic pain (NP) are common consequences following spinal cord injury (SCI), with large impact on sleep, mood, work, and quality of life. NP affects 40% to 50% of individuals with SCI and is sometimes considered the major problem following SCI. Current treatment recommendations for SCI-NP primarily focus on pharmacological strategies suggesting the use of anticonvulsant and antidepressant drugs, followed by tramadol and opioid medications. Unfortunately, these are only partly successful in relieving pain. Qualitative studies report that individuals with SCI-related long-lasting pain seek alternatives to medication due to the limited efficacy, unwanted side effects, and perceived risk of dependency. They spend time and money searching for additional treatments. Many have learned coping strategies on their own, including various forms of warmth, relaxation, massage, stretching, distraction, and physical activity. Studies indicate that many individuals with SCI are dissatisfied with their pain management and with the information given to them about their pain, and they want to know more about causes and strategies to manage pain. They express a desire to improve communication with their physicians and learn about reliable alternative sources for obtaining information about their pain and pain management. The discrepancy between treatment algorithms and patient expectations is significant. Clinicians will benefit from hearing the patient´s voice.

Keywords: neuropathic pain; nonpharmacological treatment; self-management; spinal cord injury.

Figure 1.

Questions regarding chronic pain were identified and classified into 6 main themes (square boxes). Illustrative quotes for each theme are depicted in circles. Reprinted, with permission, from Norman C, Bender JL, Macdonald J, Dunn M, Dunne S, Siu B, et al. Questions that individuals with spinal cord injury have regarding their chronic pain: a qualitative study. Disabil Rehabil. 2010;32(2):114-124. With permission from Informa.

Figure 2.

The process of moving forward with chronic neuropathic pain in spinal cord injured persons. Reprinted, with permission, from: Henwood P, Ellis JA, Logan J, Dubouloz C, D’Eon J. Acceptance of chronic neuropathic pain in spinal cord injured persons: A qualitative approach. Pain Manage Nurs. 2010. doi. org/10.1016/j.pmn.2010.05.005. Copyright © 2010 by Elsevier.