The broad, long-term objective is to reduce the occurrence and associated suffering of chronic pain secondary to either spinal cord injury (SCI) or limb loss (LL). The proposed research will (1) determine the effects of two in-hospital provided self-management pain prevention interventions -- either a hypnotic analgesia treatment or a cognitive treatment - relative to a control education treatment on pain intensity, pain interference with activities, psychological distress, and quality of life among persons with a new SCI or LL who are at risk for chronic pain; (2) test possible biopsychosocial variables that predict treatment responders/nonresponders, to determine who might most benefit from the interventions in future interventions and also for developing the interventions further to maximize efficacy; and (3) result in treatment manuals to facilitate replication (in future research) and dissemination (among clinicians).
These aims will be accomplished by a two-phase study. Phase I is a surveillance study in which individuals with a new onset of SCI or LL will be followed longitudinally from the acute care setting through 6 months postinjury (the time by which chronic pain develops). Biopsychosocial predictor variables will be collected within 1-week post-SCI or LL to develop a protocol for identifying participants who develop acute pain and associated risk factors. Phase II will be a randomized clinical trial in which persons who are identified as having severe acute pain following their injury will be randomly assigned to one of three pain treatment conditions-a cognitive restructuring intervention, a hypnotic analgesia intervention, or an education control intervention. All of the interventions will entail 8 sessions of individual therapy and are adapted from currently practiced and empirically supported interventions for chronic pain where pain is the primary complaint. However, the proposed study is unique in that these interventions have not been evaluated for their effectiveness in the prevention of chronic pain and related disability, nor have they been tested in the SCI or LL populations using a randomized clinical trial design. Measures of pain intensity, psychological functioning, pain interference with activities, participation, medical services utilization, and costs will be collected at pre-treatment, post-treatment, 3-month and 6-month follow-up.
| Ehde, Dawn M; Hanley, Marisol A (2006) Pain in patient groups frequently treated by physiatrists. Phys Med Rehabil Clin N Am 17:275-85 |
