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Widerström-Noga E, Anderson KD, Robayo LE, Perez S, Martinez-Arizala A, Calle-Coule L, Cherup NP, Fernandez GE. Development of a pain education resource for people with spinal cord injury. Front Public Health 2023; 11:1197944. [PMID: 37554730 PMCID: PMC10406314 DOI: 10.3389/fpubh.2023.1197944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023] Open
Abstract
Many people with spinal cord injury (SCI) develop chronic pain, including neuropathic pain. Unfortunately, current treatments for this condition are often inadequate because SCI-associated neuropathic pain is complex and depends on various underlying mechanisms and contributing factors. Multimodal treatment strategies including but not limited to pharmacological treatments, physical rehabilitation, cognitive training, and pain education may be best suited to manage pain in this population. In this study, we developed an educational resource named the SeePain based on published pain literature, and direct stakeholder input, including people living with SCI and chronic pain, their significant others, and healthcare providers with expertise in SCI. The SeePain was then 1) systematically evaluated by stakeholders regarding its content, comprehensibility, and format using qualitative interviews and thematic analysis, and 2) modified based on their perspectives. The final resource is a comprehensive guide for people with SCI and their significant others or family members that is intended to increase health literacy and facilitate communication between SCI consumers and their healthcare providers. Future work will quantitatively validate the SeePain in a large SCI sample.
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Affiliation(s)
- Eva Widerström-Noga
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kimberly D. Anderson
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Linda E. Robayo
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Salome Perez
- Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, FL, United States
| | - Alberto Martinez-Arizala
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lindsey Calle-Coule
- Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, FL, United States
| | - Nicholas P. Cherup
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gabriel E. Fernandez
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, United States
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Williams TL, Joseph C, Nilsson-Wikmar L, Phillips J. Exploration of the Experiences of Persons in the Traumatic Spinal Cord Injury Population in Relation to Chronic Pain Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:77. [PMID: 36612393 PMCID: PMC9819756 DOI: 10.3390/ijerph20010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Chronic pain amongst individuals with traumatic and nontraumatic spinal cord injury (SCI) has high prevalence rates, with severe impact on the activities of daily living, mood, sleep and quality of life. 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. A qualitative descriptive approach was chosen for the study, in which 13 individuals living with TSCI were purposively recruited and interviewed telephonically. An inductive thematic analytic approach was used. The results indicate ineffectiveness of standard pain management, with a lack of education regarding pain physiology and pain management strategies as well as unbalanced decision-making between clinician and patient. Thus, patients develop coping strategies to survive with pain. Current pain regimes are suboptimal at best, underpinned by the lack of clarity or a mutually agreed plan to mitigate and eradicate pain. There is a need for chronic pain management beyond pharmacological prescription. Future practices should focus on adopting a holistic, biopsychosocial approach, which includes alternative pain therapy management. In addition, advances in pain management cannot be achieved without adopting a therapeutic alliance between the clinician and patient.
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Affiliation(s)
- Tammy-Lee Williams
- Department of Physiotherapy, University of the Western Cape, Cape Town 7535, South Africa
| | - Conran Joseph
- Division of Physiotherapy, Stellenbosch University, Stellenbosch 7602, South Africa
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Lena Nilsson-Wikmar
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Joliana Phillips
- Department of Physiotherapy, University of the Western Cape, Cape Town 7535, South Africa
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Gurung S, Jenkins HT, Chaudhury H, Ben Mortenson W. Modifiable Sociostructural and Environmental Factors That Impact the Health and Quality of Life of People With Spinal Cord Injury: A Scoping Review. Top Spinal Cord Inj Rehabil 2022; 29:42-53. [PMID: 36819929 PMCID: PMC9936894 DOI: 10.46292/sci21-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective The objective of this scoping review was to identify the modifiable factors that impact the health and quality of life (QOL) of community-dwelling people with spinal cord injury (SCI). Methods Empirical journal articles were identified using three academic databases: CINAHL Complete, MEDLINE with Full Text, and PsycINFO. Full-text journal articlesincluded studies of participants who were community-dwelling with traumatic or nontraumatic SCI and were over the age of 18 years without cognitive impairment; published between 2000 and 2021; focused on modifiable factors impacting health and QOL; and conducted inAustralia, Europe, orNorth America. A data table was used to extract article information including authors, year of publication, country, sample, design and methods, purpose/objectives, and main findings. Qualitative data analysis software was used to categorize major findings inductively through content analysis. Results Thirty-one peer-reviewed articles consisting of qualitive, quantitative, and mixed-methods study design were included. This scoping review revealed modifiable factors that impact the health and QOL of community-dwelling people with SCI: sociostructural factors (social attitudes, health care access, information access, and funding and policies) and environmental factors (built environment, housing, transportation, assistive technology, and natural environment). Conclusion Future research should examine the influence of the modifiable factors on health and QOL using qualitative inquiry, adopting a community-based participatory research approach, and considering the implications of individual characteristics and resources.
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Affiliation(s)
- Shreemouna Gurung
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Hailey-Thomas Jenkins
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - W. Ben Mortenson
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Research Program, Vancouver, British Columbia, Canada
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Widerstrom-Noga E, Anderson KD, Perez S, Martinez-Arizala A, Calle-Coule L, Fleming L. Barriers and Facilitators to Optimal Neuropathic Pain Management: SCI Consumer, Significant Other, and Health Care Provider Perspectives. PAIN MEDICINE 2021; 21:2913-2924. [PMID: 32219441 DOI: 10.1093/pm/pnaa058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Persistent neuropathic pain is a common and often severe consequence of spinal cord injury (SCI). There is a critical need to better understand how to overcome barriers and promote facilitators to optimal pain management. The present study was designed to identify, from the perspectives of persons living with SCI, their significant others, and SCI health care professionals, the barriers and facilitators to optimal pain management for intense neuropathic pain. DESIGN Qualitative interviews. SETTING University laboratory. SUBJECTS People with SCI who had experienced intense neuropathic pain for a minimum of a year (N = 15), their significant others (N = 15), and SCI health care providers (N = 15). METHODS Qualitative interviews were recorded, transcribed, and analyzed based on grounded theory using ATLAS.ti software. RESULTS Inadequate access to care, information, or pain management expertise were frequently perceived barriers to optimal pain management across all three groups. Another major barrier was SCI stakeholders' concerns regarding the risks of adverse effects and addiction to pain medication. Facilitators included having a better understanding of pain and available treatment options, effective patient-provider communication, resilience, and access to nonpharmacological treatment options. CONCLUSIONS Managing intense neuropathic pain poses significant challenges after SCI. SCI stakeholders felt that accessible treatment options were limited and primarily focused on pain medications with minimal benefit but with significant risks for addiction and adverse effects. Actionable facilitators to optimal pain management after SCI include education regarding neuropathic pain and treatment options for all stakeholders, better communication regarding neuropathic pain among stakeholders, and improved patient access to nonpharmacological treatment options.
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Affiliation(s)
- Eva Widerstrom-Noga
- The Miami Project to Cure Paralysis, The University of Miami, Miami, Florida.,Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida
| | - Kim D Anderson
- The Miami Project to Cure Paralysis, The University of Miami, Miami, Florida.,Department of Physical Medicine and Rehabilitation, Metrohealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Salome Perez
- Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida
| | - Alberto Martinez-Arizala
- The Miami Project to Cure Paralysis, The University of Miami, Miami, Florida.,Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida
| | - Lindsey Calle-Coule
- Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida
| | - Loriann Fleming
- The Miami Project to Cure Paralysis, The University of Miami, Miami, Florida
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French-Lawyer J, Siano S, Ioerger M, Young V, Turk MA. Health information seeking and people with disability: A systematic search and scoping review. Disabil Health J 2020; 14:100983. [PMID: 33046431 DOI: 10.1016/j.dhjo.2020.100983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Health information and access to it are important aspects of maintaining health. There are 61 million people with disability in the U.S., many of whom experience health disparities. However, it may not be clear to health professionals how people with disability seek health information. OBJECTIVE Assess the breadth, examine the characteristics, and evaluate the risk of bias in the existing literature related to health information seeking and people with disability. METHODS The authors conducted a systematic search across five databases (Pubmed, Scopus, PsycINFO, HealthSTAR, and CINAHL) to identify empirical journal articles related to health information seeking among people with disability. Analysis of data items and a quality assessment were completed. RESULTS Forty-two articles met the criteria for inclusion and were assessed. The articles primarily used survey methodology (50%), and primarily focused on ten disability types, including MS (19%), CP (17%) and general disability (17%). The articles primarily investigated the internet (88%), and healthcare providers (71%) as sources of health information. Trustworthiness (31%), accuracy (29%), and accessibility (29%) were also commonly assessed. The overall quality was high, with room for improvement in minimizing bias. CONCLUSIONS The literature addressing health information seeking among people with disability is heterogeneous, but generally of high quality. Future research may benefit from an inclusive definition of disability and a more consistent definition of health information. Focused research on best practices and interactions among sources of health information would be valuable additions.
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Affiliation(s)
- Jeremy French-Lawyer
- Department of Physical Medicine & Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, 13244, USA.
| | - Steven Siano
- UNC School of Medicine, Chapel Hill, NC 27516, USA
| | - Michael Ioerger
- Ohio State University College of Medicine, Columbus, OH 43210, USA
| | | | - Margaret A Turk
- Department of Physical Medicine & Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, 13244, USA
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Varghese J, Anderson KD, Widerström-Noga E, Mehan U. A Primary Care Provider's Guide to Pain After Spinal Cord Injury: Screening and Management. Top Spinal Cord Inj Rehabil 2020; 26:133-143. [PMID: 33192039 PMCID: PMC7640913 DOI: 10.46292/sci2603-133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Individuals with spinal cord injury (SCI) often experience chronic pain as a secondary complication. It can significantly impair mental health, sleep, mood, and overall quality of life. It is important for providers within a primary care setting to recognize the different types of pain such as nociceptive and neuropathic. Various assessment tools are available to guide proper classification and subsequent management. Providers need to have a good knowledge base, structure, and patient focus when managing care. Nonpharmacological interventions are just as important and should be explored prior to or along with pharmacological interventions. Treatment modalities such as physical therapy, exercise, acupuncture, and cognitive behavioral therapy should be tailored to the individual to the greatest extent possible. Gabapentin, pregabalin, and amitriptyline have been studied extensively and are the first-line pharmacological agents for neuropathic pain. It is important to involve patients as equal stakeholders in any pain intervention with adequate lifelong follow-up. The aim of this article is to offer an overview of pain assessment, information, patient interaction, and treatment options available. Although chronic pain has remained difficult to treat successfully, primary care providers can play an integral role in delivering evidence-based and patient-centered care for managing chronic pain among individuals with SCI.
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Affiliation(s)
- Jithin Varghese
- Centre for Family Medicine-Family Health Team, Kitchener, Ontario, Canada
| | - Kim D. Anderson
- Department of Physical Medicine and Rehabilitation, Metrohealth Medical Center-Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Institute for Functional Restoration, Cleveland, Ohio, USA
- Cleveland Functional Electrical Stimulation Center, Cleveland, Ohio, USA
- North American SCI Consortium, Niagara Falls, New York, USA
| | - Eva Widerström-Noga
- Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
- Miami Project to Cure Paralysis, Miami, Florida, USA
| | - Upender Mehan
- Centre for Family Medicine-Family Health Team, Kitchener, Ontario, Canada
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Subgroup Perspectives on Chronic Pain and Its Management After Spinal Cord Injury. THE JOURNAL OF PAIN 2018; 19:1480-1490. [DOI: 10.1016/j.jpain.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/13/2018] [Accepted: 07/13/2018] [Indexed: 11/18/2022]
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Frequently asked questions of individuals with spinal cord injuries: results of a web-based consultation service in Iran. Spinal Cord Ser Cases 2018; 4:50. [PMID: 29951275 DOI: 10.1038/s41394-018-0085-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/31/2018] [Accepted: 04/05/2018] [Indexed: 11/08/2022] Open
Abstract
Study design Descriptive study of the results of a web-based consultation service for individuals with spinal cord injury (SCI). Objectives To review frequently asked questions (FAQ) among individuals with SCI and determine the most important topics. Setting Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. Methods A cross-sectional study reviewing questions from patients with SCI that were collected from the Health and Safety Consultant Center (HSCC) between January and December 2015. The HSCC is a web-based medical consultation service that provides patients with information and counseling pertaining to SCI. Results A total of 113 questions were collected from 99 individuals. The mean age was 32.02 ± 13.28 years with a range of 3-70 years. Men accounted for 81.7% of the questions, while women accounted for 18.3%. The most common site of SCI was thoracic (40.6%), followed by lumbar (31.3%), and cervical (28.1%). Recovery potential (38.1%), sexual and reproductive issues (26.5%), urinary (10.6%), and motor (10.6%) problems were among the most commonly reviewed topics. Conclusions FAQ provide insight on areas of concerns for individuals with SCI and help guide providers to determine high-yield topics. Discerning the specific areas of need or concern for patients is instrumental in developing pertinent educational materials and programs, in addition to efficiently counseling patients and caregivers on the aftercare of SCI.
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Lennox A, Gabbe B, Nunn A, Braaf S. Experiences With Navigating and Managing Information in the Community Following Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 24:315-324. [PMID: 30459494 DOI: 10.1310/sci17-00050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: People living with spinal cord injury (SCI) have reported difficulties managing information in the community, which can negatively impact their functional independence and ability to prevent secondary complications. Objective: This exploratory qualitative study aimed to describe the experiences of people living with SCI with navigating and managing information in the community from their perspective. Methods: Participants were recruited through the Australian Quadriplegic Association. Twenty-two semi-structured in-depth interviews were conducted with purposively selected participants to ensure representation of age, gender, SCI level, and compensation status. Data were thematically analyzed using a framework approach. Results: People living with SCI reported using multiple, complementary sources of information to prevent and manage secondary conditions. Over time, they learned to appraise the content, relevance, timing, and sources of information. Information delivered by health professionals in the rehabilitation setting was appraised as lacking personalization, but it acted as a springboard to search for more relevant information. Participants described the process of becoming experts about their condition to overcome the lack of knowledge of many general practitioners, guide their own care, and act as a source of information for others. Due to a lack of information provision, some participants missed health improvement opportunities and experienced frustration at the uncertainty of their future with SCI. Conclusion: Greater support is required for individuals with SCI to navigate information sources in the community. Rehabilitation is an opportune time to provide education related to finding and appraising information. Improved access to community health providers with SCI knowledge is also required.
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Affiliation(s)
- Alyse Lennox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Melbourne, Victorian, Australia
| | - Sandra Braaf
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Hitzig SL, Hunter JP, Ballantyne EC, Katz J, Rapson L, Craven BC, Boschen KA. Outcomes and reflections on a consensus-building workshop for developing a spinal cord injury-related chronic pain research agenda. J Spinal Cord Med 2017; 40:258-267. [PMID: 26828394 PMCID: PMC5472012 DOI: 10.1080/10790268.2015.1136115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Context/ Objective: Chronic pain following spinal cord injury (SCI) is a prevalent secondary health condition that significantly impacts quality of life (QoL). Although growing, the number of available effective pain management approaches for SCI is limited. Recognizing the need to "kick-start" activity on this topic, a consensus-building workshop on developing a research agenda for SCI-related chronic pain was held in 2006 with an expert panel. The present paper describes the processes of the consensus-workshop and its associated outcomes towards advancing the research agenda for SCI-related pain in Canada. A commentary on the current state of knowledge regarding SCI-related pain is also provided. METHODS Thirty-nine stakeholders (researchers, clinicians, policy-makers, SCI advocates, and people with SCI) attended the consensus-workshop. A modified Delphi approach was employed to gain consensus on identifying the top five SCI pain research priorities for improving QoL post-SCI. As well, project planning along with infrastructure support opportunities were discussed. RESULTS The top five pain research priorities were: 1) pain management and treatment; 2) measurement tools; 3) health services policy and advocacy; 4) knowledge transfer; and 5) mechanisms of pain. Recommendations related to the priorities and related resources were generated, and pilot work was initiated. CONCLUSIONS The consensus workshop provided an initial roadmap for research on SCI-related chronic pain, and supported five pilot projects on the identified priorities. Reflections on the current research landscape in Canada and abroad suggest increased activity towards addressing pain post-SCI but evidence-based approaches are still lacking.
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Affiliation(s)
- Sander L. Hitzig
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
- Institute for Life Course and Aging, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Judith P. Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Elena C. Ballantyne
- St- Joseph's Healthcare, Hamilton, Ontario, Canada
- Bieman-Copland & Associates, St. Catharines, Ontario, Canada
| | - Joel Katz
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Linda Rapson
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kathryn A. Boschen
- Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada
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Buscemi V, Cassidy E, Kilbride C, Reynolds FA. A qualitative exploration of living with chronic neuropathic pain after spinal cord injury: an Italian perspective. Disabil Rehabil 2017; 40:577-586. [PMID: 28054832 DOI: 10.1080/09638288.2016.1271023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to understand how people with spinal cord injury (SCI) in Italy experienced and managed chronic neuropathic pain (CNP), and their perspectives of Italian healthcare services. METHOD Nine people with SCI participated. Two focus groups (three and four individuals) and one semi-structured interview were audio-recorded and transcribed. One "virtual interview" was conducted via e-mail. A qualitative thematic analysis was undertaken. RESULTS Three main themes were identified. First, participants experienced pain as a powerful, intrusive and, at times, inescapable force, with the potential to overwhelm the sense of self, and place limits on enjoyable experiences. Second, participants recounted a strong desire to understand CNP, and, in the absence of expert guidance, used trial-and-error methods to find ways of relieving pain. Third, healthcare practice was perceived as pharmacologically focused and lacking specialist knowledge. Practitioners were described as reluctant to explore alternative therapies or participate in collaborative, patient-centred care. CONCLUSIONS This study reveals SCI-related CNP as a deeply troubling and psychologically distressing condition impacting widely on everyday life. Specialist, collaborative, individually tailored rehabilitation approaches that attend to patients' priorities and experiences, include education about CNP, and offer opportunities to explore complementary treatments, may be welcomed by people living with this condition in Italy. Implications for Rehabilitation People living in Italy with SCI-related CNP describe inadequate and ineffective pain relief. The impact of CNP on physical, psychological and social functioning is significant but may be an issue that continues to be underestimated by health professionals. Health professionals may better support patients living in Italy with SCI-related CNP by providing long-term, individualized, collaborative and specialist support. Ongoing, patient-led discussion forums where experiences, ideas and information can be shared may be useful to persons with SCI to help them cope with their pain over the long-term.
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Affiliation(s)
- Valentina Buscemi
- a Department of Clinical Sciences , College of Health and Life Sciences, Brunel University London , Uxbridge , United Kingdom
| | - Elizabeth Cassidy
- a Department of Clinical Sciences , College of Health and Life Sciences, Brunel University London , Uxbridge , United Kingdom
| | - Cherry Kilbride
- a Department of Clinical Sciences , College of Health and Life Sciences, Brunel University London , Uxbridge , United Kingdom
| | - Frances Ann Reynolds
- a Department of Clinical Sciences , College of Health and Life Sciences, Brunel University London , Uxbridge , United Kingdom
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Widerström-Noga E, Anderson KD, Perez S, Hunter JP, Martinez-Arizala A, Adcock JP, Escalona M. Living With Chronic Pain After Spinal Cord Injury: A Mixed-Methods Study. Arch Phys Med Rehabil 2016; 98:856-865. [PMID: 27894730 DOI: 10.1016/j.apmr.2016.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 10/20/2016] [Accepted: 10/25/2016] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Eva Widerström-Noga
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Bruce W. Carter Veterans Affairs Medical Center, Miami, FL.
| | - Kimberly D Anderson
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Bruce W. Carter Veterans Affairs Medical Center, Miami, FL
| | - Salomé Perez
- Bruce W. Carter Veterans Affairs Medical Center, Miami, FL
| | - Judith P Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alberto Martinez-Arizala
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Bruce W. Carter Veterans Affairs Medical Center, Miami, FL
| | - James P Adcock
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL; Bruce W. Carter Veterans Affairs Medical Center, Miami, FL
| | - Maydelis Escalona
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL; Bruce W. Carter Veterans Affairs Medical Center, Miami, FL
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Hache G, Guiard BP, Nguyen TH, Quesseveur G, Gardier AM, Peters D, Munro G, Coudoré F. Antinociceptive activity of the new triple reuptake inhibitor NS18283 in a mouse model of chemotherapy-induced neuropathic pain. Eur J Pain 2015; 19:322-33. [PMID: 25045036 DOI: 10.1002/ejp.550] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Chronic neuropathic pain can lead to anxiety and depression. Drugs that block reuptake of serotonin, norepinephrine and/or dopamine are widely used to treat depression, and have emerged as useful drugs in the treatment of neuropathic pain. This study compared the acute antinociceptive effects of NS18283, a novel triple monoamine reuptake inhibitor (MRI) with indatraline, venlafaxine and escitalopram in a mouse model of neuropathic pain. METHOD Neuropathic pain-like behaviours were induced in mice by repeated injections of oxaliplatin (OXA), and assessed using the von Frey hair test, the cold plate test and the thermal preference plate test. Anxio/depressive phenotype and antidepressant-like properties of compounds were assessed by the novelty suppressed feeding test and the tail suspension test, respectively. RESULTS In vivo microdialysis experiments showed that each MRI increased extracellular serotonin, norepinephrine and/or dopamine levels in the cingulate cortex, in agreement with their in vitro reuptake inhibitory properties. Indatraline (3 mg/kg) reversed the full repertoire of OXA-induced neuropathic hypersensitivity. NS18283 (10 mg/kg) reversed OXA-induced mechano-hypersensitivity and cold allodynia. Venlafaxine (16 mg/kg) and escitalopram (4 mg/kg) only reversed cold allodynia and mechano-hypersensitivity, respectively. All MRIs produced antidepressant-like activity in anxio/depressive phenotype of OXA mice. CONCLUSIONS Acute administration of drugs that enhance the activity of serotonin, norepinephrine and dopamine neurotransmission within nociceptive pathways may provide a broader spectrum of antinociception than dual or selective reuptake inhibitors in animal models of neuropathic pain. Whether similar observations would occur after repeated administration of such compounds in an attempt to simulate dosing in humans, or be compromised by dopaminergic-mediated adverse effects warrants further investigation.
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Affiliation(s)
- G Hache
- Faculty of Pharmacy, Paris Sud University, Châtenay-Malabry Cedex, France
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14
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Bea-Muñoz M, Medina-Sánchez M, Flórez-García MT. Quality of websites with patient information about spinal cord injury in Spanish. Spinal Cord 2015; 54:540-5. [PMID: 26481713 DOI: 10.1038/sc.2015.190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/06/2015] [Accepted: 09/20/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Descriptive, cross-sectional analysis of websites with information on spinal cord injury (SCI) in Spanish. OBJECTIVE To assess the quality, readability and presence of quality labels on web pages with information about SCI in Spanish. SETTING The Internet. METHODS An Internet search was conducted on Google with the keywords 'lesión medular' (spinal cord injury), 'paraplejia' (paraplegia) and 'tetraplejia' (tetraplegia). The first 50 results of each search were included. The quality of websites was assessed with the LIDA tool while the readability was assessed with the Flesch-Szigriszt index and the INFLESZ scale. We also checked the presence of any quality label. RESULTS After excluding duplicated and irrelevant results, 33 websites were analysed. Only four of them had a quality label. The mean score of the LIDA tool was 61.12% (medium quality), and the worst results were those referring to the reliability of the information. The readability of the web pages was somewhat difficult, with a mean of 48.22 in the Flesch-Szigriszt index. Only eight of the websites showed normal readability. We observed no differences in either the quality or the readability of the websites according to their origin or the presence of quality labels. CONCLUSIONS The websites analysed present a medium quality. Mainly, they should improve the reliability of their contents and their readability, including more quality labels. For SCI information in Spanish to be understandable and to provide valuable content, websites analysed in our study need to improve the quality parameters.
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Affiliation(s)
- M Bea-Muñoz
- Neurological Rehabilitation Unit, Rehabilitation Service, Hospital Universitario Central de Asturias, Oviedo, Spain
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15
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Norrbrink C, Löfgren M. Needs and requests – patients and physicians voices about improving the management of spinal cord injury neuropathic pain. Disabil Rehabil 2015; 38:151-8. [DOI: 10.3109/09638288.2015.1035456] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Cecilia Norrbrink
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden,
- Department of Neurobiology, Care sciences and Society, Karolinska Institute, Stockholm, Sweden, and
| | - Monika Löfgren
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden,
- Department of Rehabilitation Medicine Stockholm, Danderyd Hospital, Stockholm, Sweden
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16
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Hearn JH, Cotter I, Fine P, A. Finlay K. Living with chronic neuropathic pain after spinal cord injury: an interpretative phenomenological analysis of community experience. Disabil Rehabil 2015; 37:2203-11. [DOI: 10.3109/09638288.2014.1002579] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Nasirinezhad F, Gajavelli S, Priddy B, Jergova S, Zadina J, Sagen J. Viral vectors encoding endomorphins and serine histogranin attenuate neuropathic pain symptoms after spinal cord injury in rats. Mol Pain 2015; 11:2. [PMID: 25563474 PMCID: PMC4349602 DOI: 10.1186/1744-8069-11-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 12/16/2014] [Indexed: 12/22/2022] Open
Abstract
Background The treatment of spinal cord injury (SCI)-induced neuropathic pain presents a challenging healthcare problem. The lack of available robust pharmacological treatments underscores the need for novel therapeutic methods and approaches. Due to the complex character of neuropathic pain following SCI, therapies targeting multiple mechanisms may be a better choice for obtaining sufficient long-term pain relief. Previous studies in our lab showed analgesic effects using combinations of an NMDA antagonist peptide [Ser1]histogranin (SHG), and the mu-opioid peptides endomorphins (EMs), in several pain models. As an alternative to drug therapy, this study evaluated the analgesic potential of these peptides when delivered via gene therapy. Results Lentiviruses encoding SHG and EM-1 and EM-2 were intraspinally injected, either singly or in combination, into rats with clip compression SCI 2 weeks following injury. Treated animals showed significant reduction in mechanical and thermal hypersensitivity, compared to control groups injected with GFP vector only. The antinociceptive effects of individually injected components were modest, but the combination of EMs and SHG produced robust and sustained antinociception. The onset of the analgesic effects was observed between 1–5 weeks post-injection and sustained without decrement for at least 7 weeks. No adverse effects on locomotor function were observed. The involvement of SHG and EMs in the observed antinociception was confirmed by pharmacologic inhibition using intrathecal injection of either the opioid antagonist naloxone or an anti-SHG antibody. Immunohistochemical analysis showed the presence of SHG and EMs in the spinal cord of treated animals, and immunodot-blot analysis of CSF confirmed the presence of these peptides in injected animals. In a separate group of rats, delayed injection of viral vectors was performed in order to mimic a more likely clinical scenario. Comparable and sustained antinociceptive effects were observed in these animals using the SHG-EMs combination vectors compared to the group with early intervention. Conclusions Findings from this study support the potential for direct gene therapy to provide a robust and sustained alleviation of chronic neuropathic pain following SCI. The combination strategy utilizing potent mu-opioid peptides with a naturally-derived NMDA antagonist may produce additive or synergistic analgesic effects without the tolerance development for long-term management of persistent pain.
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Affiliation(s)
| | | | | | | | | | - Jacqueline Sagen
- Miami Project to Cure Paralysis, University of Miami Miller School Of Medicine, Miami, FL 33136, USA.
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18
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Mattar AAG, Hitzig SL, McGillivray CF. A qualitative study on the use of personal information technology by persons with spinal cord injury. Disabil Rehabil 2014; 37:1362-71. [DOI: 10.3109/09638288.2014.963708] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Sander L. Hitzig
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada and
| | - Colleen F. McGillivray
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada and
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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19
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Mann EG, Lefort S, Vandenkerkhof EG. Self-management interventions for chronic pain. Pain Manag 2014; 3:211-22. [PMID: 24654764 DOI: 10.2217/pmt.13.9] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
SUMMARY Individuals living with chronic pain face daily challenges of managing symptoms, modifying roles and responsibilities, and coping with the negative emotional consequences of pain. Self-management interventions teach a variety of strategies to meet these challenges and build participants' self-efficacy for their use. These interventions have been delivered in individual, group and online formats for a variety of different pain conditions. The evidence supports the efficacy of self-management interventions in improving pain, mental health and health-related quality of life outcomes. Acceptance of the chronic nature of their pain is a necessary step before individuals are ready to self-manage. Clinicians can play a critical role in supporting self-management through answering questions, providing advice, addressing barriers and facilitators, and encouraging self-management efforts.
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Affiliation(s)
- Elizabeth G Mann
- School of Nursing, Queen's University, Cataraqui Building, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada
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20
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Salbach NM, O'Brien K, Evans C, Yoshida K. Dissemination of student research in a canadian master of science in physical therapy programme. Physiother Can 2014; 65:154-7. [PMID: 24403678 DOI: 10.3138/ptc.2012-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the extent of presentation and publication, as well as time to publication, of student research completed as a component of a Master of Science in Physical Therapy (MScPT) degree at a Canadian university. METHOD The authors conducted a retrospective cross-sectional study of MScPT research projects completed between 2003 and 2009, each undertaken by a group of MScPT students who carried out protocol development, ethics submission, data collection, analysis, and manuscript and poster preparation under the supervision of research advisors. Research advisors were e-mailed a request for citations of presentations and publications. RESULTS Advisors from 102 of 113 research projects completed from 2003 through 2009 provided information, for a response rate of 90.3%. Of the 102 groups, 53.9% disseminated findings through publication or presentation, 33.3% presented at one or more conferences, and 30.4% published at least one peer-reviewed journal article. Median time to publication was 21 months. Almost half the journal articles (47%) were published in Physiotherapy Canada. CONCLUSIONS MScPT student research groups are disseminating their findings through publication or presentation at a moderate rate. Investigation of factors influencing dissemination is needed to develop strategies to facilitate knowledge transfer.
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Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Kelly O'Brien
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Cathy Evans
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Karen Yoshida
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
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21
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MacNeela P, Doyle C, O'Gorman D, Ruane N, McGuire BE. Experiences of chronic low back pain: a meta-ethnography of qualitative research. Health Psychol Rev 2013; 9:63-82. [DOI: 10.1080/17437199.2013.840951] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Padraig MacNeela
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Catherine Doyle
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - David O'Gorman
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Department of Anaesthesia, Galway University Hospital, Galway, Ireland
| | - Nancy Ruane
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Department of Anaesthesia, Galway University Hospital, Galway, Ireland
| | - Brian E. McGuire
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Department of Anaesthesia, Galway University Hospital, Galway, Ireland
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22
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Nielsen M, Jull G, Hodges PW. Information needs of people with low back pain for an online resource: a qualitative study of consumer views. Disabil Rehabil 2013; 36:1085-91. [PMID: 24001260 DOI: 10.3109/09638288.2013.829532] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To identify the information needs of people with low back pain (LBP) in Australia, and the preferred methods to present this information online, as a basis for development of a patient-centred website. Available online LBP resources are limited in quality and content and it is not clear if they are meeting the needs of sufferers. METHOD Focus groups and semi-structured telephone interviews, involving 28 people with LBP. RESULTS Seven categories of information were identified: reasons for LBP, treatment and management options, self-help information, psychological and social dimensions, lay stories, quality assurance of information and roles of different healthcare professionals and locally available services. Identified preferences for online presentation included: multimodality, emphasis on visual media, readability and interactivity. Participants had been unable to obtain desired LBP information using existing resources. CONCLUSIONS This study provides important guidance for development of a patient-centred website grounded in the expressed needs and preferences of people with LBP. Understanding the breadth of patients' questions and concerns is essential for provision of patient-centred information and interventions. Incorporating these with the current evidence base would provide an accessible and relevant LBP patient education referral point, which is currently lacking. Implications for Rehabilitation Use of the internet to obtain health information is increasing, although there is little evidence that existing low back pain websites are meeting the expressed needs of health consumers. Our research suggests that people with low back pain have difficulty finding relevant and trustworthy information about the condition on the internet. Taking patient information needs and presentation preferences into account when designing online information material will provide people with low back pain an accessible and relevant educational resource that is currently lacking.
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Affiliation(s)
- Mandy Nielsen
- Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland , Brisbane, QLD , Australia
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23
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Norrbrink C, Löfgren M, Hunter JP, Ellis J. Patients' perspectives on pain. Top Spinal Cord Inj Rehabil 2013; 18:50-6. [PMID: 23459087 DOI: 10.1310/sci1801-50] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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.
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25
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Roscigno CI. Challenging nurses' cultural competence of disability to improve interpersonal interactions. J Neurosci Nurs 2013; 45:21-37. [PMID: 23291869 PMCID: PMC3609418 DOI: 10.1097/jnn.0b013e318275b23b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Worldwide, at least 6.9 billion people have an impairment-producing health condition. Insensitive encounters with healthcare providers (HCPs) can result in negative appraisals, fear, and avoidance, but little is known about what things are commonly perceived as insensitive. A review of published narratives describing negative encounters with HCPs was conducted. Narrative analysis was used to compare, contrast, and synthesize six themes describing the common negative encounters: (a) ignoring or minimizing their knowledge, (b) detached interpersonal interactions, (c) placing a negative skew on their life quality, (d) lack of HCP knowledge related to their complete needs, (e) assuming they should be asexual and childless, and (f) an inherent power differential. The medical model of disability is perceived by individuals with impairment-producing health conditions to inform negative encounters perceived as insensitive. This preliminary knowledge is important so we can address educational needs, plan future research questions, and establish clinical practice improvements.
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Affiliation(s)
- Cecelia I Roscigno
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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26
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Löfgren M, Norrbrink C. “But I know what works” – patients’ experience of spinal cord injury neuropathic pain management. Disabil Rehabil 2012; 34:2139-47. [DOI: 10.3109/09638288.2012.676146] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Oxycodone improves pain control and quality of life in anticonvulsant-pretreated spinal cord-injured patients with neuropathic pain. Spinal Cord 2010; 49:36-42. [PMID: 20820176 DOI: 10.1038/sc.2010.101] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN A 3-month follow-up, observational, prospective, multicenter, study in traumatic spinal cord-injured (SCI) patients with neuropathic pain (NP). OBJECTIVES To assess the effectiveness and safety of oxycodone treatment in SCI patients with anticonvulsants-refractory NP. SETTING 'Spinal injury follow-up units' throughout Spain. METHODS Data regarding NP characteristics were collated from male and female adults with traumatic SCI and difficult-to-control central NP of moderate-to-severe intensity (visual analog scale (VAS) ≥4) persisting ≥1 month, who had been para- or tetraplegic for ≥2 months, had been previously treated with anticonvulsants and were now treated with oxycodone. RESULTS In all, 54 out of the 57 patients recruited were assessable. A total of 81% were men and the mean age was 46.4. Patients were treated with oxycodone, 83% combined with anticonvulsant. Pain intensity (VAS: 7.1 ± 1.3-4.3 ± 1.7) and Lattinen total score (13.2 ± 3-7.7 ± 3.4) decreased significantly (P < 0.001) along the study. No patient got worse regarding pain impact on physical activity and on sleep (Lattinen scale). EQ-5D VAS showed a trend to increase (P = 0.061) and the index of preference values increased significantly from baseline to month 3 (0.26-0.62; P < 0.001). A total of 53.7% patients showed at least one treatment-related adverse event, with constipation being the most frequent one (33.3%). CONCLUSION Oxycodone treatment, mostly in combination with anticonvulsants, in SCI patients with NP decreases pain intensity, improves health-related quality of life and diminishes the impact of pain on physical activity and sleep.
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