Pain self management after spinal cord injury: State-of-the science

Objective: There is considerable evidence of chronic pain after spinal injuries. Pharmacological management is costly and may have unwanted side effects. With a policy emphasis in the UK and elsewhere towards enhancing self management among individuals with long term conditions it is important to examine the evidence base for pain self management after spinal cord injury.

Design: Systematic Literature Review

Participants/methods: Databases PUBMED, MEDLINE, EMBASE, CINAHL, and DARE. Where possible, we used expert search strings (e.g. Cochrane; Centres for Reviews and Dissemination). Internet searches using Google TM were conducted to identify grey literature. There were no limits by design, intervention or clinical characteristics. Searches were restricted to the time October 1996 – October 2006.

Results: Pain after SCI is well documented but not sufficiently recognized as a self management intervention focus. The review only identified 15 studies that discussed some form of pain self-management. Not a single randomized control trial was found. Pharmacological approaches had limited success in controlling chronic pain. Different sources of persistent pain post-injury could be identified. Based on the UK's Medical Research Council's Evaluation Framework most studies were classified as pre-clinical, modelling or exploratory studies. Sample sizes were generally small. Studies were grouped by objective, design, and finding.

Conclusions: Psychologically based self-management strategies are highly underutilized in the regulation of chronic pain after SCI. Cognitive-behavioral therapy-based self management interventions have shown promise to positively modulate pain in other long term conditions. Further research is needed to determine the effectiveness of pain self management after spinal cord injury.