When the pain is the problem
Experiencing pain in a part of the body that is unable to sense much else seems one of the cruellest ironies of having a spinal cord injury (SCI). For people with SCI persisting pain can be as much of a barrier to participating in daily activities as SCI’s more well-known problems.
The majority of people with SCI experience pain at one time or another, and it can contribute to psychological difficulties such as depression. It can also make it more difficult to take part in activities such as socialising and work.
There is still plenty we need to know about the causes of such pain, how it affects the lives of people with SCI living in Australia, and how best to manage it. A number of researchers in NSW and throughout Australia are working on this problem from a range of perspectives: why it starts, how it affects people’s lives and how people can learn to manage it better.
In order to find out more about how pain might develop, Dr Philip Siddall and colleagues at the University of Sydney Pain Management and Research Centre are investigating the contribution of brain mechanisms to the presence of pain following SCI. This project follows on from previous studies that identified changes in electrical activity in association with pain.
With grant funding obtained from the NSW Government and the Spinal Research Foundation, they are collaborating with Dr James Middleton of the Moorong Spinal Injuries Unit and Dr Sue Rutkowski of the Royal North Shore Hospital Spinal Injuries Unit to examine several aspects of brain mechanisms that may be involved in the development of pain in people with spinal cord injury. It is hoped that identification of brain changes will help in finding a treatment of this difficult condition.
With her supervisors A/Prof Michael Nicholas and Dr James Middleton and other colleagues in the University of Sydney Pain Management and Research Centre and spinal services at Royal North Shore Hospital and Royal Rehabilitation Centre, Sydney, we are studying impact of this pain, and its management. Our work focuses on understanding the way in which chronic pain affects the lives of those with SCI and how they might develop strategies to minimise its impact.
While we know much about the factors that predict how well someone in the general population will learn to live with chronic pain, little is known about how applicable this is to people with SCI. Data collection is about to start on a national survey of people with SCI living in the community to help expand our understanding of the prevalence of chronic pain in this group and its association with disability and distress.
They hope that this work will allow them to clarify the influence of factors such as self-efficacy (confidence to cope with activities despite pain) and catastrophic thinking (the tendency to assume the worst when in pain) on pain related disability and distress. Dr Siddall and colleagues are also planning to build on their existing work to chart the course of such problems and in particular to examine the relationship between factors soon after injury and later pain, disability and distress. They will be following a group whose injury occurred approximately ten years ago to assist in identifying risk factors for developing chronic pain in this population.
Applying cognitive behavioural principles of treatment that have been so successful in other areas of chronic pain, the ADAPT Pain Management Programme has been modified to address the needs of people with spinal cord injuries who are clients of the University of Sydney Pain Management and Research Centre. After a pilot group run in 2003, a revised version is now being offered and the participants will be followed for nine months to monitor the impact of the programme on pain-related disability and distress, as well as some of the factors thought to be associated with it. Later in the year this approach will also be introduced as part of the rehabilitation process at the Moorong Spinal Unit (Royal Rehabilitation Centre, Sydney) to help people adjust and learn to better manage pain after SCI.
If you are interested in participating in the national survey of pain in people with spinal cord injury, please contact Kathryn Nicholson Perry (Clinical Psychologist) at the PO Box 613, Glebe NSW 2037 or via e-mail at knperry@nsccahs.health.nsw.gov.au, or
