Widerstrom-Noga Eva, Anderson Kim D, Perez Salome, Martinez-Arizala Alberto, Calle-Coule Lindsey, Fleming Loriann
The Miami Project to Cure Paralysis, The University of Miami, Miami, Florida.
Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida.
Pain Med. 2020 Nov 1;21(11):2913-2924. doi: 10.1093/pm/pnaa058.
Persistent neuropathic pain is a common and often severe consequence of spinal cord injury (SCI). There is a critical need to better understand how to overcome barriers and promote facilitators to optimal pain management. The present study was designed to identify, from the perspectives of persons living with SCI, their significant others, and SCI health care professionals, the barriers and facilitators to optimal pain management for intense neuropathic pain.
Qualitative interviews.
University laboratory.
People with SCI who had experienced intense neuropathic pain for a minimum of a year (N = 15), their significant others (N = 15), and SCI health care providers (N = 15).
Qualitative interviews were recorded, transcribed, and analyzed based on grounded theory using ATLAS.ti software.
Inadequate access to care, information, or pain management expertise were frequently perceived barriers to optimal pain management across all three groups. Another major barrier was SCI stakeholders' concerns regarding the risks of adverse effects and addiction to pain medication. Facilitators included having a better understanding of pain and available treatment options, effective patient-provider communication, resilience, and access to nonpharmacological treatment options.
Managing intense neuropathic pain poses significant challenges after SCI. SCI stakeholders felt that accessible treatment options were limited and primarily focused on pain medications with minimal benefit but with significant risks for addiction and adverse effects. Actionable facilitators to optimal pain management after SCI include education regarding neuropathic pain and treatment options for all stakeholders, better communication regarding neuropathic pain among stakeholders, and improved patient access to nonpharmacological treatment options.
持续性神经性疼痛是脊髓损伤（SCI）常见且往往较为严重的后果。迫切需要更好地了解如何克服障碍并促进实现最佳疼痛管理的推动因素。本研究旨在从脊髓损伤患者、其重要他人以及脊髓损伤医护专业人员的角度，确定严重神经性疼痛最佳疼痛管理的障碍和促进因素。
定性访谈。
大学实验室。
经历严重神经性疼痛至少一年的脊髓损伤患者（N = 15）、他们的重要他人（N = 15）以及脊髓损伤医护人员（N = 15）。
定性访谈进行录音、转录，并使用ATLAS.ti软件基于扎根理论进行分析。
在所有三组中，获得护理、信息或疼痛管理专业知识不足常被视为最佳疼痛管理的障碍。另一个主要障碍是脊髓损伤相关利益者对疼痛药物不良反应和成瘾风险的担忧。促进因素包括对疼痛和可用治疗选择有更好的理解、有效的医患沟通、恢复力以及获得非药物治疗选择。
脊髓损伤后管理严重神经性疼痛面临重大挑战。脊髓损伤相关利益者认为可及的治疗选择有限，主要集中在止痛药物上，益处极小但成瘾和不良反应风险很大。脊髓损伤后最佳疼痛管理的可行促进因素包括对所有利益相关者进行神经性疼痛和治疗选择的教育、利益相关者之间关于神经性疼痛的更好沟通，以及改善患者获得非药物治疗选择的机会。
