Long-term outcomes of a multidisciplinary cognitive behavioural programme for coping with chronic neuropathic spinal cord injury pain.

OBJECTIVE: To explore the long-term outcomes of CONECSI (COping with NEuropathiC Spinal cord Injury pain), a multidisciplinary cognitive behavioural treatment programme in persons with spinal cord injury. DESIGN: Long-term follow-up pre-post-intervention design. SUBJECTS: A total of 29 subjects with a spinal cord injury and chronic neuropathic pain from 4 Dutch rehabilitation centres. METHODS: Primary outcomes were pain intensity and pain-related disability (Chronic Pain Grade questionnaire). Secondary outcomes were mood (Hospital Anxiety and Depression Scale), participation in activities (Utrecht Activities List), and life satisfaction (Life Satisfaction Questionnaire). Random coefficient analysis was used for the analyses of measurements before (t1), immediate post-intervention (t2), and 6 (t3), 9 (t4), and 12 (t5) months follow-up. RESULTS: The analyses showed significant improvements on pain intensity (t1-t2 and t1-t5) and pain-related disability (t1-t2, t1-t4, and t1-t5), anxiety and participation in activities (t1-t2, t1-t3, and t1-t5). CONCLUSION: This exploratory study suggests that a multidisciplinary cognitive behavioural programme might have lasting improvements on pain intensity, pain-related disability, anxiety, and participation in activities in people with chronic neuropathic spinal cord injury pain and highlights the potential of such programmes.

Which pain coping strategies and cognitions are associated with outcomes of a cognitive behavioral intervention for neuropathic pain after spinal cord injury?

BACKGROUND: Chronic neuropathic pain is one of the most difficult problems to manage after spinal cord injury (SCI). Pain coping and pain cognitions are known to be associated with the patient's experience of neuropathic pain, but they have not been studied in the context of a cognitive behavioral treatment program for coping with neuropathic pain after SCI. OBJECTIVE: To explore associations of pain coping strategies and cognitions with pain intensity and pain-related disability and changes in pain coping strategies and cognitions with changes in pain intensity and pain-related disability. METHODS: Forty-seven persons who participated in the CONECSI (COping with NEuropathiC Spinal cord Injury pain) trial completed questionnaires before the intervention (baseline) and 3 months after of the intervention (follow-up). RESULTS: Compared to baseline, participants showed more favorable scores on 2 pain coping scales (Pain Transformation and Worrying), the subtotal score Active Coping, and 3 pain cognitions scales (Catastrophizing, Optimism, and Reliance on Health Care) at follow-up. Baseline Reliance on Health Care was associated with change in pain intensity and pain-related disability. Change in Catastrophizing and change in Restriction cognitions were associated with change in pain-related disability. CONCLUSIONS: Our findings suggest that modifying pain coping strategies and cognitions by a cognitive behavioral intervention for chronic neuropathic pain after SCI may have some beneficial effects on pain intensity and pain-related disability. Further research should show how dysfunctional pain coping strategies and cognitions can be most effectively modified.

The CONECSI trial: results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury.

Many people with spinal cord injury (SCI) rate chronic neuropathic pain as one of the most difficult problems to manage. The aim of the CONECSI (COping with NEuropathiC Spinal cord Injury pain) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI. The intervention consisted of educational, cognitive, and behavioral elements. A total of 61 people were randomized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers. Primary outcomes were pain intensity and pain-related disability (Chronic Pain Grade questionnaire), and secondary outcomes were mood (Hospital Anxiety and Depression Scale), participation in activities (Utrecht Activities List), and life satisfaction (Life Satisfaction Questionnaire). Measurements were performed at baseline, and at 3, and 6 months follow-up. The primary statistical technique was random coefficient analysis. The analyses showed significant changes over time on both primary (t1-t2), and 2 out of 4 secondary outcomes (both t1-t2 and t1-t3). Significant intervention effects (Time*Group interactions) were found for anxiety and participation in activities, but not for the primary outcomes. Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group: decrease of pain intensity, pain-related disability, anxiety, and increase of participation in activities. This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain.

Chronic spinal cord injury pain: pharmacological and non-pharmacological treatments and treatment effectiveness.

PURPOSE: To describe pharmacological and non-pharmacological pain treatments used for chronic spinal cord injury pain (CSCIP) and current treatment effectiveness in a large Dutch population with a spinal cord injury (SCI). METHOD: Postal survey among 575 persons with SCI. The main outcome measures were the pain intensity score of the Chronic Pain Grade questionnaire, past and current pain treatments, and perceived effectiveness of current pain treatments. RESULTS: Response rate was 49% (279 persons) and 215 respondents (77.1%) had CSCIP. Most respondents with CSCIP (62.8%) reported more than one pain type, of which neuropathic pain was most frequently reported (69.3%). Of this group with CSCIP, 63.8% was currently involved in some kind of treatment, but nevertheless high levels of pain (mean 52.8 on a 0-100 scale) were reported. Massage (therapy)/relaxation (training), anticonvulsants, and non-steroidal anti-inflammatory drugs (NSAIDs) were the most often used treatments. The current treatments that were most often perceived as effective were acupuncture/magnetising, cannabis/alcohol, physiotherapy and exercise, and massage (therapy)/relaxation (training). TENS/ultrasound and antidepressants were least often perceived as effective. CONCLUSIONS: Many SCI pain treatments have been tried. Acupuncture/magnetising, cannabis/alcohol, and physiotherapy and exercise were considered most effective. Further research is needed to establish effective SCI pain treatments.

A multidisciplinary cognitive behavioural programme for coping with chronic neuropathic pain following spinal cord injury: the protocol of the CONECSI trial.

BACKGROUND: Most people with a spinal cord injury rate neuropathic pain as one of the most difficult problems to manage and there are no medical treatments that provide satisfactory pain relief in most people. Furthermore, psychosocial factors have been considered in the maintenance and aggravation of neuropathic spinal cord injury pain. Psychological interventions to support people with spinal cord injury to deal with neuropathic pain, however, are sparse. The primary aim of the CONECSI (COping with NEuropathiC Spinal cord Injury pain) trial is to evaluate the effects of a multidisciplinary cognitive behavioural treatment programme on pain intensity and pain-related disability, and secondary on mood, participation in activities, and life satisfaction. METHODS/DESIGN: CONECSI is a multicentre randomised controlled trial. A sample of 60 persons with chronic neuropathic spinal cord injury pain will be recruited from four rehabilitation centres and randomised to an intervention group or a waiting list control group. The control group will be invited for the programme six months after the intervention group. Main inclusion criteria are: having chronic (> 6 months) neuropathic spinal cord injury pain as the worst pain complaint and rating the pain intensity in the last week as 40 or more on a 0-100 scale. The intervention consists of educational, cognitive, and behavioural elements and encompasses 11 sessions over a 3-month period. Each meeting will be supervised by a local psychologist and physical therapist. Measurements will be performed before starting the programme/entering the control group, and at 3, 6, 9, and 12 months. Primary outcomes are pain intensity and pain-related disability (Chronic Pain Grade questionnaire). Secondary outcomes are mood (Hospital Anxiety and Depression Scale), participation in activities (Utrecht Activities List), and life satisfaction (Life Satisfaction Questionnaire). Pain coping and pain cognitions will be assessed with three questionnaires (Coping Strategy Questionnaire, Pain Coping Inventory, and Pain Cognition List). DISCUSSION: The CONECSI trial will reveal the effects of a multidisciplinary cognitive behavioural programme for people with chronic neuropathic spinal cord injury pain. This intervention is expected to contribute to the rehabilitation treatment possibilities for this population. TRIAL REGISTRATION: Dutch Trial Register NTR1580.

Autonomic reactivity to sensory stimulation is related to consciousness level after severe traumatic brain injury.

OBJECTIVE: To examine changes in the activity of the autonomic nervous system (ANS) that are related to recovery to consciousness in the post-acute phase after severe traumatic brain injury (sTBI). METHODS: Skin conductance and heart rate reactivity to sensory stimulation were recorded every 2 weeks for an average period of 3.5 months in 16 adolescent patients, during the assessment of their level of consciousness (LoC), and their cognitive and functional behaviour. RESULTS: Both heart rate variability (HRV) and skin conductance level (SCL) in reaction to sensory stimulation changed with recovery to consciousness. Indices of HRV and SCL that represent sympathetic activity of the autonomic nervous system (ANS) increased with recovery, whereas indices that represent parasympathetic activity decreased. In addition, we observed an increase in sympathovagal balance of the ANS with recovery. CONCLUSIONS: Recovery to consciousness determined by clinical observation in sTBI in the post-acute phase is related to changes in SCL and HRV during sensory stimulation. ANS reactivity to environmental stimulation can therefore give objective supplementary information about the clinical state of sTBI patients, and can contribute to decision-making in the treatment policy of unresponsive patients. SIGNIFICANCE: These findings demonstrate that autonomic reactivity can be informative concerning how a severely damaged nervous system reacts to environmental stimulation and how, in a recovering nervous system, this reactivity changes.