Evaluation of a multidisciplinary cognitive behavioural programme for coping with chronic neuropathic pain following spinal cord injury.

Background:

The effective treatment of pain following spinal cord is difficult. Particularly in regards to neuropathic spinal cord injury pain, there are no treatments that produce satisfactory pain relief in most people. Therefore, psychosocial factors in the maintenance and aggravation of chronic pain following spinal cord injury have been considered.



Objective:

To evaluate a multidisciplinary cognitive behavioural programme for coping with chronic neuropathic pain following spinal cord injury.



Study design:

A multi-centre, randomised intervention study with a waiting list control group. Care as usual will continue, but patients will be requested to held pain medication and other pain treatments constant during the intervention period (3 months). A maximum of 80 persons will be included (four intervention groups of 10 persons and four control groups of 10 persons).



Study population:

Patients visiting the outpatient departments of rehabilitation centre De Hoogstraat (Utrecht), Rijndam (Rotterdam), Het Roessingh (Enschede), and Adelante zorggroep (Hoensbroek) will be invited to participate.



Study parameters:

Demographic (e.g., age and gender), disease and pain characteristics (e.g., type of SCI), pain treatment, and functional independence (Barthel Index) will be registered at the baseline measurement. The participants complete a questionnaire on satisfaction with the programme immediately after completion of the programme at 3 months. Measures of primary and secondary outcomes, and pain treatment will be administered at all measurements. Psychological variables will be administered at t1, t2, t3, and t5.

A multidisciplinary cognitive behavioural programme for coping with chronic neuropathic pain following spinal cord injury has a positive effect on pain intensity and pain related disability.

t1 (start intervention)

t2 (end intervention)

t3 (3 months follow-up)

t4 (6 months follow-up)

t5:(9 months follow-up)

The multidisciplinary programme, comprising educational, cognitive, and behavioural interventions for coping with chronic neuropathic pain following spinal cord injury, consists of ten sessions of 3 hours over a 10-week period and a comeback session three weeks later. Each meeting will be supervised by a psychologist and physical therapist assisted by guest speakers and a role model in three sessions. The intervention is directed at knowledge about chronic neuropathic pain, modifying passive coping, negative illness cognitions and feelings of depression and hopelessness, at relaxation and attention-distraction techniques and at stimulating an active lifestyle.

Elements of the intervention are:

1. provision of information;

2. guided group discussions;

3. exercises and sport workshops;

4. homework.