Cognitive behavioural treatment programme for chronic neuropathic pain after spinal cord injury

Abstract

People with spinal cord injury (SCI) often face serious secondary health conditions, including different types of pain. Neuropathic pain is often rated by them as the most severe type of pain. Pharmacological interventions are often insufficiently effective in providing neuropathic pain relief and, consequently, there is a growing interest in non-pharmacological interventions for neuropathic pain. One of the non-pharmacological treatment options is cognitive behavioural treatment, but the usefulness of this approach is unclear. The general aim of this thesis is to describe SCI pain treatments and their effectiveness, and to develop and evaluate a cognitive behavioural treatment programme for people with chronic neuropathic pain after SCI. The CONECSI (COping with NEuropathiC Spinal cord Injury pain) randomised clinical trial (RCT) was conducted to evaluate the effects of this developed cognitive behavioural programme, primary, on pain intensity and pain-related disability, and, secondary, on mood, participation in activities, and life satisfaction. Pain coping strategies and pain cognitions were also assessed. People with chronic neuropathic SCI pain were recruited from 4 rehabilitation centres and randomised to an intervention group or a waiting list control group. The control group was invited for the programme 6 months after the intervention group. Measurements were performed before starting the programme (intervention group) or before entering the control group, and at 3, 6, 9, and 12 months. The intervention consisted of educational, cognitive, and behavioural elements, sports workshops and relaxation techniques, and encompassed 11 group sessions of 3 hours over a 3-month period. In the RCT, 31 persons were randomised in the intervention group and 30 persons were randomised in the waiting list control group. The short-term (3 months post-intervention) results of the CONECSI trial showed a significant positive effect of the cognitive behavioural programme on anxiety (decrease) and participation in activities (increase). Besides this, a significant decrease in pain intensity and pain-related disability was found over time in the intervention group, but without a significant difference between intervention group and waiting list control group. No differences were found for depression and life satisfaction. The long-term data of the intervention group (9 months post-intervention) showed a significant decrease of pain intensity, pain-related disability, and anxiety, and a significant increase in participation in activities. Although the scores changed in the expected direction, no significant change over time was found for depression and life satisfaction. Examination of the associations of pain coping strategies and pain cognitions with pain intensity and pain-related disability support the notion that it is possible to modify dysfunctional pain coping strategies and pain cognitions by a cognitive behavioural intervention, with a beneficial effect of this approach on pain intensity and pain-related disability. The results presented in this thesis highlight the potential value of a cognitive behavioural programme for persons with chronic neuropathic SCI pain who experience insufficient relief of neuropathic pain from conventional therapy.