Feasibility of Brief, Hypnotic Enhanced Cognitive Therapy for SCI-related Pain During Inpatient Rehabilitation

OBJECTIVES

(1) Adapt evidence-based hypnosis-enhanced cognitive therapy (HYP-CT) for inpatient rehabilitation setting; and (2) determine feasibility of a clinical trial evaluating the effectiveness of HYP-CT intervention for pain after spinal cord injury (SCI).

STUDY DESIGN

Pilot non-randomized controlled trial.

SETTING

Inpatient rehabilitation unit.

PARTICIPANTS

English-speaking patients admitted to inpatient rehabilitation after SCI reporting current pain of at least 3 on a 0-10 scale. Persons with severe psychiatric illness, recent suicide attempt or elevated risk, or significant cognitive impairment were excluded. Consecutive sample of 53 patients with SCI-related pain enrolled, representing 82% of eligible patients.

INTERVENTION

Up to 4 sessions of HYP-CT Intervention, each 30-60 minutes long.

METHODS

Participants were assessed at baseline and given the choice to receive HYP-CT or Usual Care.

MAIN OUTCOME MEASURES

Participant enrollment and participation and acceptability of intervention. Exploratory analyses examined the effect of intervention on pain and cognitive appraisals of pain.

RESULTS

In the HYP-CT group, 71% completed at least 3 treatment sessions and reported treatment benefit and satisfaction with the treatment; no adverse events were reported. Exploratory analyses of effectiveness found pre-post treatment pain reductions after HYP-CT with large effect (P<.001; β=-1.64). While the study was not powered to detect significant between-group differences at discharge, effect sizes revealed decreases in average pain (Cohen's d=-0.13), pain interference (d=-0.10), and pain catastrophizing (d=-0.20) in the HYP-CT group relative to control and increases in self-efficacy (d=0.27) and pain acceptance (d=0.15).

CONCLUSIONS

It is feasible to provide HYP-CT to inpatients with SCI, and HYP-CT results in substantial reductions in SCI pain. The study is the first to show a psychological-based nonpharmacologic intervention that may reduce SCI pain during inpatient rehabilitation. A definitive efficacy trial is warranted.

A Case Study of Hypnosis Enhanced Cognitive Therapy for Pain in a Ventilator Dependent Patient during Inpatient Rehabilitation for Spinal Cord Injury

Early, acute pain following spinal cord injury (SCI) is common, can negatively impact SCI rehabilitation, and is frequently not responsive to biomedical treatment. Nonpharmacological interventions show promise in reducing pain for individuals with SCI. However, most psychological interventions rely heavily on verbal interaction between the individual being treated and the clinician, making them inaccessible for individuals with impaired verbal output due to mechanical ventilation. This case study aims to describe the adaptation and implementation of hypnotic cognitive therapy (HYP-CT) intervention for early SCI pain in the context of mechanical ventilation dependence and weaning. The participant was a 54-year-old male with C2 AIS A SCI requiring mechanical ventilation. Four sessions of HYP-CT were provided during inpatient rehabilitation with assessment prior to intervention, after the intervention sessions, and prior to discharge. The participant reported immediate reductions in pain intensity following each intervention session. Overall, he reported increases in self-efficacy and pain acceptance. He did not report any negative treatment effects and thought the intervention provided support during mechanical ventilation weaning. During treatment, he discontinued opioid pain medications and reported actively using intervention strategies. Our results support the potential for early, hypnotic cognitive therapy for individuals with SCI experiencing pain or distress while dependent on mechanical ventilation.

Survey of internship training in rehabilitation psychology: 2019

PURPOSE/OBJECTIVE

The purpose of this study was to obtain information about psychology internship training programs involving work with individuals with disabilities receiving rehabilitation services in the United States and Canada.

RESEARCH METHOD/DESIGN

The Association of Psychology Postdoctoral and Internship Centers (APPIC) directory was used to identify 426 training programs that listed supervised experience in rehabilitation psychology, and these programs were sent a survey assessing characteristics of their internship. There were 227 program directors who responded (53%), and 114 of them reported that their internship involved working with disabled persons receiving rehabilitation services.

RESULTS

The majority of training programs were at a hospital or subacute rehabilitation facility (Veteran Affairs and non-Veteran Affairs), and 41% of the programs were housed within an independent psychology department. Sixteen programs (15%) had faculty who were board certified by the American Board of Rehabilitation Psychology (ABRP).

CONCLUSIONS/IMPLICATIONS

Interns were exposed to a broad range of conditions, such as brain injuries, orthopedic, and spinal cord injuries, as well as comorbid psychiatric and substance use disorders. Interns were also provided various levels of training in ABRP competencies across programs. Opportunities to improve training with rehabilitation populations at the internship level include increasing didactics related to rehabilitation psychology and increasing opportunities to work with ABRP faculty. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

An Acute Pain Service experience initiating methadone for opioid use disorder in hospitalized patients with acute pain

OBJECTIVE

Inform readers of the use of a clinical pathway that includes initiation of methadone in hospitalized patients with acute pain who have untreated opioid use disorder (OUD).

DESIGN

A retrospective chart review with frequency distributions and descriptive statistics calculated to describe demo-graphic and clinical characteristics of the sample.

SETTING

Urban academic hospital.

PATIENTS

One hundred twenty consecutive patients with untreated OUD cared for by the Acute Pain Service (APS).

INTERVENTIONS

APS leadership spearheaded development of a clinical pathway to standardize pain management and optimize outcomes. The authors outline pathway development and describe 120 patients managed using this pathway, initiated on methadone for OUD.

RESULTS

The sample included patients, average age 40 years, predominantly non-Hispanic white (74.2 percent), male (61.7 percent), unemployed (88.2 percent), and on Medicaid (84.2 percent). 96.7 percent had a history of heroin use, and 52.1 percent had engaged in previous medication-assisted treatment (MAT). Methadone or other opioids were held for signs of intoxication/sedation in 10.9 percent or for prolonged corrected QT interval in 1.7 percent. The majority received at least one other analgesic agent. For those prescribed opioids upon discharge, the average maximum morphine equivalent dose was 68.2 mg/day for approximately 3 days. 68.3 percent agreed to schedule post-discharge MAT, and of these, 68 percent attended their intake appointment. A small percentage (4.7 percent) left the hospital against medical advice.

CONCLUSION

This pathway provides an example of an effective and safe response to address the opioid epidemic and pro-vide quality care to patients with OUD and pain.