Clinical Study Spotlight: Pain and SCI

August 2014 – Dr. Eva Widerström-Noga has been studying chronic pain for over 20 years as well, with an emphasis on SCI since 1996.  More than two-thirds of individuals living with SCI experience chronic, persistent pain.  Dr. Widerström-Noga is an international leader in SCI pain research and classification.  The field knows most about pain assessment and classification.  There are 2 main types of pain: 1) nociceptive and 2) neuropathic.  Nociceptive pain is typically experienced in muscles/joints/bones or internal body organs and can often be effectively treated with various pain medications.  Neuropathic pain is currently defined as “pain initiated or caused by a primary lesion or dysfunction in the nervous system”, ex. pain that develops as a direct result of damage to the spinal cord.  This pain can be at the level of injury or below the level of injury and it is very resistant to current pain medications.  Dr. Widrström-Noga’s research group has demonstrated that SCI neuropathic pain tends to manifest in 3 distinct symptom profiles:  1) aching, throbbing pain, exacerbated by cold weather and constipation; 2) stabbing, penetrating, and constant pain of high intensity; and 3) burning, electric, and stinging pain aggravated by mechanical stimuli such as touch and muscle spasms.  These different symptom profiles are each associated with a significant degree of biological and psychological stress.  No treatments are currently available that completely relieve neuropathic pain after SCI.  So how do people cope with this?

That is the exact topic of a grant Dr. Widerström-Noga was awarded last year from the Department of Defense with Dr. Anderson as a Co-Investigator.  It is titled “Experiences of Living with Persistent Pain After a Spinal Cord Injury”.  It is a qualitative study being conducted in two parts.  The first part is interview-based and involves 35 individuals living with SCI and neuropathic pain.  These interviews will provide her team with comprehensive, in-depth, first-hand insight on what it’s like to live with chronic pain after SCI and what people do to cope with this pain.  The second part will be a larger scale survey based on the findings of the first part, with the goal of making sure the results apply to the larger SCI population and determining how pain and coping with pain may change with time since injury or be dependent on injury severity, gender, etc.

The main objective of the whole study is to explore the perceptions of individuals with SCI and chronic pain regarding barriers and facilitators:
•    for living and coping with pain and SCI;
•    to activities and participation;
•    to pain relief from treatments and self-administered remedies, and the role of social support

The long term goal of this research is to facilitate the management of SCI related chronic pain by increasing the knowledge regarding the barriers and facilitators to living with a SCI and chronic pain, from the individuals with SCI point of view. We expect that this information will be useful for other individuals who live with an SCI and chronic pain and their families, as well as for health care providers, and clinical researchers.