TY - JOUR
T1 - Living With Chronic Pain After Spinal Cord Injury
T2 - A Mixed-Methods Study
AU - Widerström-Noga, Eva
AU - Anderson, Kimberly D.
AU - Perez, Salomé
AU - Hunter, Judith P.
AU - Martinez-Arizala, Alberto
AU - Adcock, James P.
AU - Escalona, Maydelis
N1 - Funding Information:
Supported by the U.S. Department of Defense (grant nos. SC110195/SC140052) and The Miami Project to Cure Paralysis.
Publisher Copyright:
© 2016 American Congress of Rehabilitation Medicine
PY - 2017/5
Y1 - 2017/5
N2 - Objective To identify the relative importance of positive (facilitators) and negative (barriers) contributors to living with chronic pain after spinal cord injury (SCI). Design Mixed-methods: (1) Qualitative (n=35): individual, semistructured, open-ended interviews identifying facilitator/barrier themes; (2) Quantitative (n=491): converting the most common themes into statements and quantifying agreement with these in an online survey to determine relative importance, underlying dimensions, and their associations with perceived difficulty in dealing with pain. Setting University-based research setting and general community. Participants Volunteers (N=526) with SCI experiencing moderate to severe chronic pain. Interventions Not applicable. Main Outcome Measures Interview guides, facilitator/barrier statements, and pain inventories. Results Exploratory factor analyses reduced agreement ratings into 4 facilitators (information regarding pain and treatments, resilience, coping, medication use) and 5 barriers (poor health care communication, pain impact and limitations, poor communication about pain, difficult nature of pain, treatment concerns). Greater “pain impact and limitations,” “difficult nature of pain,” “poor communication from provider,” lower “resilience,” greater “medication use,” and younger age predicted greater difficulty in dealing with pain (r=.75; F=69.02; P<.001). Conclusions This study revealed multiple facilitators and barriers to living with chronic pain after SCI. The principal barrier, “poor health care communication,” indicated that consumers do not receive adequate information from their health care providers regarding pain. “Information regarding pain and treatments” had greater agreement scores and factor loadings than all other facilitators, indicating that most participants view provider-patient communication and educational efforts regarding pain and pain management as priorities and critical needs. Further initiatives in these areas are important for improving pain management post-SCI.
AB - Objective To identify the relative importance of positive (facilitators) and negative (barriers) contributors to living with chronic pain after spinal cord injury (SCI). Design Mixed-methods: (1) Qualitative (n=35): individual, semistructured, open-ended interviews identifying facilitator/barrier themes; (2) Quantitative (n=491): converting the most common themes into statements and quantifying agreement with these in an online survey to determine relative importance, underlying dimensions, and their associations with perceived difficulty in dealing with pain. Setting University-based research setting and general community. Participants Volunteers (N=526) with SCI experiencing moderate to severe chronic pain. Interventions Not applicable. Main Outcome Measures Interview guides, facilitator/barrier statements, and pain inventories. Results Exploratory factor analyses reduced agreement ratings into 4 facilitators (information regarding pain and treatments, resilience, coping, medication use) and 5 barriers (poor health care communication, pain impact and limitations, poor communication about pain, difficult nature of pain, treatment concerns). Greater “pain impact and limitations,” “difficult nature of pain,” “poor communication from provider,” lower “resilience,” greater “medication use,” and younger age predicted greater difficulty in dealing with pain (r=.75; F=69.02; P<.001). Conclusions This study revealed multiple facilitators and barriers to living with chronic pain after SCI. The principal barrier, “poor health care communication,” indicated that consumers do not receive adequate information from their health care providers regarding pain. “Information regarding pain and treatments” had greater agreement scores and factor loadings than all other facilitators, indicating that most participants view provider-patient communication and educational efforts regarding pain and pain management as priorities and critical needs. Further initiatives in these areas are important for improving pain management post-SCI.
KW - Chronic pain
KW - Qualitative research
KW - Rehabilitation
KW - Spinal cord injuries
KW - Surveys and questionnaires
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U2 - 10.1016/j.apmr.2016.10.018
DO - 10.1016/j.apmr.2016.10.018
M3 - Article
C2 - 27894730
AN - SCOPUS:85010950474
VL - 98
SP - 856
EP - 865
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
SN - 0003-9993
IS - 5
ER -