BACKGROUND:Chronic neuropathic pain (CNP) in spinal cord injury (SCI) is recognized as severely compromising, in both adjustment after injury and quality of life. Studies indicate that chronic pain in SCI is associated with great emotional distress over and above that of the injury itself. Currently, little is known about the SCI patient's perception of the impact of living with chronic neuropathic pain.OBJECTIVES:The purpose of this study was to explore the experience of CNP in SCI patients in relation with physical, emotional, psychosocial, environmental, informational, practical and spiritual domains, and to identify effective and ineffective pain coping strategies.METHODS:Three focus groups were conducted that included 24 SCI individuals living in the community. Participants were selected to maximize variation in terms of type of SCI, Frankel classification, years since onset of SCI, age and sex. The sessions were audiotaped and tapes were transcribed. A qualitative analysis of data involved a constant comparison approach, in which categories and themes were identified.RESULTS:Many complex themes emerged including: nature of pain; coping as process and product; medication failure; and the impact of CNP on physical, cognitive, emotional, interpersonal, social and life activities.CONCLUSIONS:Medication failure was identified as a common outcome, while strategies including use of warm water, swimming, increased activity and distraction provided temporary pain relief. Learning to live with the pain appeared to be related to acceptance of pain, which in turn seemed to facilitate adjustment. Further research is warranted to determine the process by which SCI patients learn to live with CNP and coping strategies that facilitate adjustment to CNP in SCI patients.
The impact of coping on emotional adjustment to spinal cord injury (SCI): review of the literature and application of a stress appraisal and coping formulation