Eva Widerstrom-Noga, Ph.D.

Interdisciplinary Neuropathic Pain Research Program

Background: Most people with spinal cord injury (SCI) or traumatic brain injury (TBI) develop chronic pain, including pain that is neuropathic in nature. Chronic pain regardless of type substantially compromises quality of life and independent living after SCI by disrupting sleep, mood, physical and social activities. Neuropathic pain affects about 60% of people with SCI and is particularly challenging to treat due to its heterogenous mechanisms and multiple contributing factors. Therefore, multimodal treatment strategies including pain education, pharmacological, physical, and cognitive approaches may be optimal for pain management [1]. Identifying effective strategies to reduce neuropathic pain and its impact on quality of life after SCI remains a critical research priority for our lab.

There is a critical need for effective non-pharmacological pain management approaches that can be combined, when appropriate, with pharmacological treatments to optimize pain reduction.  Improving the effectiveness and accessibility of pain management after SCI requires a deeper understanding of underlying pain mechanisms, predictors of treatment response, individuals’ treatment preferences, and the development of interventions that can be adapted for home-based, self-administered use.

Our interdisciplinary research program focuses on spinal cord injury and the neuropathic pain experienced by many individuals after injury. By integrating multiple areas of pain research, our long-term goal is to better understand the factors that contribute to neuropathic pain development and severity and to develop novel approaches that support more effective pain self-management.

Pain Education
Our research team developed SeePain, an educational resource grounded in pain science literature and informed by interviews with individuals living with SCI and chronic pain, their significant others, and healthcare providers with SCI expertise. The SeePain is a comprehensive guide designed to improve health literacy and enhance communication between individuals with SCI and their healthcare providers. Its goal is to help individuals better understand and manage pain and to reduce its impact on quality of life. This freely available resource has served as the foundation for integrating pain education into a non-pharmacological pain management program, the feasibility and impact of which have been evaluated in two recent publications [2–4].

Multimodal Pain Program
In CDMRP-supported work, we evaluated a multimodal pain management program combining circuit-based upper body exercise, bodily illusions, and pain education. This study was developed in direct response to SCI stakeholders’ strong interest in non-pharmacological approaches and pain education [5,6]. Participants reported multiple benefits following program completion, including reduced pain and pain interference, improved understanding of pain and its management, and decreased medication use. Additional benefits included an expanded mindset, enhanced community and interpersonal connections, positive health effects, increased motivation, and improved self-image. These outcomes were supported by pain assessment measures demonstrating significant reductions in neuropathic pain severity, pain interference with activities and mood, and difficulty dealing with pain [7].

Multisensory Integration
SCI affects not only motor function but also the brain’s ability to integrate multisensory information. A key area of our research examines cognitive mechanisms of multisensory body representation using electrophysiological techniques, including EEG, and chronometric measures [8–12]. This work aims to clarify how disruptions in multisensory body representation contribute to neuropathic pain, and to inform the development of novel non‑pharmacological strategies to modulate pain symptoms.

Consistent with this approach, our ongoing CDMRP‑funded project investigates how the brain processes body‑related information using EEG and how alterations in these processes contribute to the development of neuropathic pain after SCI. The project also examines the effects of combining non‑invasive transcranial direct current stimulation with bodily illusions on neuropathic pain and sensory function.

Bodily illusions modulate the brain’s integration of multisensory input, including visual, auditory, tactile, and proprioceptive signals, and have been shown to reduce neuropathic pain after SCI. To optimize their therapeutic effectiveness, we are examining the relationship between these neural mechanisms and pain reduction, with the goal of tailoring treatment protocols to individuals most likely to benefit.

This research will advance our understanding of how multisensory integration contributes to neuropathic pain after SCI and informs the development of novel treatment approaches. In addition, in‑depth qualitative interviews with individuals experiencing moderate to severe neuropathic pain will provide critical insights into perceived benefits, risks, and overall experiences with non‑invasive brain stimulation combined with bodily illusions.