• Eva Widerström-Noga, Kimberly D Anderson, Salomé Perez, Judith P Hunter, Alberto Martinez-Arizala, James P Adcock, and Maydelis Escalona.
• 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. Electronic address: EWiderstrom-Noga@med.miami.edu.
• Arch Phys Med Rehabil. 2017 May 1; 98 (5): 856-865.

ObjectiveTo identify the relative importance of positive (facilitators) and negative (barriers) contributors to living with chronic pain after spinal cord injury (SCI).DesignMixed-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.SettingUniversity-based research setting and general community.ParticipantsVolunteers (N=526) with SCI experiencing moderate to severe chronic pain.InterventionsNot applicable.Main Outcome MeasuresInterview guides, facilitator/barrier statements, and pain inventories.ResultsExploratory 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).ConclusionsThis 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.Copyright © 2016 American Congress of Rehabilitation Medicine. All rights reserved.

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