Pain has a significant impact on the functioning of individuals with spinal cord injuries (IWSCI) and individuals with amputations (IWA). Limited attention has been given to methods for preventing post- amputation pain (PAP), overuse pain in IWSCI, or to treating chronic pain in these groups. The Program Core includes: Administrative, Assessment, Clinical Services, Engineering, and Data Analysis divisions. The main purposes of the Program Core are to facilitate: (a) the successful completion of the 3 projects contained in the program project; (b) the acquisition of knowledge that will permit prevention of the development of chronic pain and accompanying disability; and, (c) dissemination of information. Centralizing responsibilities within the Core should reduce duplication, facilitate community liaison, assist in recruitment of, and issues across projects. The 3 projects in this Program Project are designed to cover the spectrum from prevention of pain to rehabilitation of individuals who suffer from chronic pain secondary to SCI and amputations. PROJECT I. WHEELCHAIR ERGONOMICS AND CHRONIC PAIN PREVENTION will use kinetic and kinematic analysis to: (a) reduce the frequency, severity, and duration of pain in IWSCI through optimal wheelchair fitting and a cushioned, high-friction pushrim; and (b) reduce the progression of peripheral pathology through optimal wheelchair fitting and a cushioned, high-friction pushrim. PROJECT II. TREATING CHRONIC PAIN FOLLOWING SCI AND AMPUTATION will: (a) compare IWSCI and IWA with pain to chronic pain patients on psychosocial, behavioral, and functional measures; (b) assess the efficacy of the combination of physical therapy = cognitive-behavioral therapy (CBT+PT) for IWSCI and IWA and pain; and (c) to evaluate the usefulness of a trial of opioid medication added to the CBT+PT. PROJECT III. MEASURING OUTCOMES IN PAIN TREATMENT OF SCI & AMPUTATION will: (a) track functional changes in acute SCI; (b) evaluate a set of physical capacity protocols and kinesiological analytic techniques for determining the functional abilities of IWSCI and IWA with pain and the impact of treatment on these measures; and (c) use Item Response Theory to evaluate the adequacy of a set of measures used to evaluate chronic pain patients for use with SCI and PAP and assess the utility of these measures in quantifying treatment outcomes. A unique feature of this proposal is the inclusion of rehabilitation science and advanced biometric analyses with clinical interventions. The integration of the projects should facilitate the acquisition of knowledge about pain and SCI and amputations. It offers promise for the development of methods to prevent pain following amputations and overuse syndromes, as well as pain control and improved functioning in these populations.
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