Widerström-Noga Eva, Anderson Kimberly D, Perez Salomé, Hunter Judith P, Martinez-Arizala Alberto, Adcock James P, Escalona Maydelis
The Miami Project to Cure Paralysis, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Bruce W. Carter Veterans Affairs Medical Center, Miami, FL.
The Miami Project to Cure Paralysis, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Bruce W. Carter Veterans Affairs Medical Center, Miami, FL.
Arch Phys Med Rehabil. 2017 May;98(5):856-865. doi: 10.1016/j.apmr.2016.10.018. Epub 2016 Nov 25.
To identify the relative importance of positive (facilitators) and negative (barriers) contributors to living with chronic pain after spinal cord injury (SCI).
Mixed-methods: (1) Qualitative (n=35): individual, semistructured, open-ended interviews identifying facilitator/barrier themes; (2) Quantitative (n=491): converting the most common themes into statements and quantifying agreement with these in an online survey to determine relative importance, underlying dimensions, and their associations with perceived difficulty in dealing with pain.
University-based research setting and general community.
Volunteers (N=526) with SCI experiencing moderate to severe chronic pain.
Not applicable.
Interview guides, facilitator/barrier statements, and pain inventories.
Exploratory factor analyses reduced agreement ratings into 4 facilitators (information regarding pain and treatments, resilience, coping, medication use) and 5 barriers (poor health care communication, pain impact and limitations, poor communication about pain, difficult nature of pain, treatment concerns). Greater "pain impact and limitations," "difficult nature of pain," "poor communication from provider," lower "resilience," greater "medication use," and younger age predicted greater difficulty in dealing with pain (r=.75; F=69.02; P<.001).
This study revealed multiple facilitators and barriers to living with chronic pain after SCI. The principal barrier, "poor health care communication," indicated that consumers do not receive adequate information from their health care providers regarding pain. "Information regarding pain and treatments" had greater agreement scores and factor loadings than all other facilitators, indicating that most participants view provider-patient communication and educational efforts regarding pain and pain management as priorities and critical needs. Further initiatives in these areas are important for improving pain management post-SCI.
确定脊髓损伤（SCI）后慢性疼痛患者生活中积极因素（促进因素）和消极因素（障碍因素）的相对重要性。
混合方法：（1）定性研究（n = 35）：进行个体、半结构化、开放式访谈，以确定促进因素/障碍因素主题；（2）定量研究（n = 491）：将最常见的主题转化为陈述，并在在线调查中对这些陈述的认可度进行量化，以确定相对重要性、潜在维度及其与感知疼痛处理难度的关联。
大学研究机构和普通社区。
526名患有中度至重度慢性疼痛的SCI志愿者。
不适用。
访谈指南、促进因素/障碍因素陈述和疼痛量表。
探索性因素分析将认可度评分归纳为4个促进因素（疼痛及治疗信息、恢复力、应对方式、药物使用）和5个障碍因素（医疗保健沟通不畅、疼痛影响及限制、疼痛沟通不良、疼痛性质复杂、治疗担忧）。“疼痛影响及限制”“疼痛性质复杂”“医疗服务提供者沟通不良”程度越高，“恢复力”越低，“药物使用”越多，以及年龄越小，预示着疼痛处理难度越大（r = 0.75；F = 69.02；P < 0.001）。
本研究揭示了SCI后慢性疼痛患者生活中的多种促进因素和障碍因素。主要障碍因素“医疗保健沟通不畅”表明患者未从医疗服务提供者处获得足够的疼痛相关信息。“疼痛及治疗信息”的认可度得分和因素负荷高于所有其他促进因素，这表明大多数参与者将医疗服务提供者与患者之间关于疼痛及疼痛管理的沟通和教育工作视为优先事项和关键需求。在这些领域采取进一步举措对于改善SCI后的疼痛管理非常重要。
