Treatments perceived to be helpful for neuropathic pain after traumatic spinal cord injury: A multicenter cross-sectional survey study

Abstract

Design

Cross-sectional survey.

Objective

To evaluate the perceived helpfulness of pharmacological and non-pharmacological interventions and their combinations for neuropathic pain (NeuP) and subcategories of NeuP after spinal cord injury (SCI).

Setting

Six Spinal Cord Injury Model System Centers.

Methods

Three hundred ninety one individuals at least one year post traumatic SCI were enrolled. A telephone survey was conducted to determine the pharmacologic and non-pharmacologic treatments used in the last 12 months for each participant’s three worst pains, whether these treatments were “helpful”, and if currently used, each treatments’ effectiveness.

Results

Two hundred twenty participants (56%) reported 354 distinct NeuPs. Pharmacological treatments rated helpful for NeuP were non-tramadol opioids (opioids were helpful for 86% of opioid treated NeuPs), cannabinoids (83%), and anti-epileptics (79%). Non-pharmacological treatments rated helpful for NeuP were massage (76%), body position adjustment (74%), and relaxation therapy (70%). Those who used both opioids and exercise reported greater NeuP treatment helpfulness compared to participants using opioids without exercise (P = 0.03).

Conclusions

Opioids, cannabinoids, and massage were reported more commonly as helpful than treatments recommended as first-line therapies by current clinical practice guidelines (CPGs) for NeuP after SCI (antiepileptics and antidepressants). Individuals with SCI likely value the modulating effects of pharmacological and non-pharmacological treatments on the affective components of pain in addition to the sensory components of pain when appraising treatment helpfulness.

Keywords:

• Neuropathic pain
• Spinal cord injury
• Pharmacological treatment
• Non-pharmacological treatment
• Opioids

Acknowledgements

Susie Charlifue, PhD, Jeff Berliner, DO, and Lisa Spielman, PhD critically reviewed the manuscript and Laiba Afzal helped with the data analysis.

Disclaimer statements

Contributors TNB was responsible for designing the work that led to the submission, interpreting results, and drafting and revising the manuscript. CYT was responsible for designing the work that led to the submission, acquiring and analyzing the data, interpreting results, and drafting and revising the manuscript. ADD was responsible for designing the work that led to the submission, screening/recruiting eligible participants, and acquiring and analyzing the data. AW, SJM, and HT were responsible for designing the work that led to the submission, interpreting results, and revising the manuscript. DC and ERF were responsible for designing the work that led to the submission, coordinating data collection and quality control across participating centers interpreting the results, and revising the manuscript.

Funding The contents of this manuscript were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research [NIDILRR grant numbers 90SI5017, 90SI5027, 90SI5023, 90SI5018, 90SI5015, 90SI5019, 90DP0083]. NIDILRR is a Institute within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

Conflicts of interest Thomas N. Bryce, Chung-Ying Tsai, Andrew D. Delgado, Sara J. Mulroy, Abigail Welch, Diana D. Cardenas, Heather B. Taylor, and Elizabeth R. Felix, declare no proprietary, financial, professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled, “Treatments perceived to be helpful for neuropathic pain after traumatic spinal cord injury: A multicenter cross-sectional survey study”.

Data archiving The data generated and analyzed during the current study are available through the Spinal Cord Injury Model Systems upon request.

Statement of ethics Institutional Review Board approval (HSM# 11-01603) was obtained prior to conducting any study related procedures, and informed consent was obtained from each participant. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.