Topics in spinal cord injury rehabilitation
-
Top Spinal Cord Inj Rehabil · Jan 2013
Which pain coping strategies and cognitions are associated with outcomes of a cognitive behavioral intervention for neuropathic pain after spinal cord injury?
Chronic neuropathic pain is one of the most difficult problems to manage after spinal cord injury (SCI). Pain coping and pain cognitions are known to be associated with the patient's experience of neuropathic pain, but they have not been studied in the context of a cognitive behavioral treatment program for coping with neuropathic pain after SCI. ⋯ Our findings suggest that modifying pain coping strategies and cognitions by a cognitive behavioral intervention for chronic neuropathic pain after SCI may have some beneficial effects on pain intensity and pain-related disability. Further research should show how dysfunctional pain coping strategies and cognitions can be most effectively modified.
-
Top Spinal Cord Inj Rehabil · Jan 2013
Neuropathic pain post spinal cord injury part 2: systematic review of dorsal root entry zone procedure.
Pharmacotherapy may not sufficiently reduce neuropathic pain in many individuals post spinal cord injury (SCI). The use of alternative therapies such as surgery may be effective in reducing neuropathic pain in these individuals. However, because of the invasive nature of surgery, it is important to examine the evidence for use of this treatment. ⋯ The studies demonstrated that the DREZ procedure may be effective in reducing segmental pain. Hence, DREZ may be important in treatment of neuropathic pain in individuals resistant to less invasive treatments. Because the studies lacked control conditions and examination of long-term effects, there is a need for larger trials with more stringent conditions.
-
Top Spinal Cord Inj Rehabil · Jan 2013
Cardiovascular function in individuals with incomplete spinal cord injury: a systematic review.
There is a clear relationship between the neurological level of spinal cord injury (SCI) and cardiovascular function; however, the relationship between completeness of injury and cardiovascular function is less straightforward. Traditionally completeness of injury has referred to neurological (motor/sensory) completeness. Recently, a number of studies have started to investigate autonomic completeness of injury. ⋯ For acute SCI, there is no clear consensus whether cardiovascular function differs between complete and incomplete. For chronic SCI, the studies to date suggest that autonomic completeness of SCI is more strongly related to cardiovascular function than neurological completeness of injury. Thus, clinicians and scientists should account for autonomic completeness of injury when assessing cardiovascular function in SCI.
-
Top Spinal Cord Inj Rehabil · Jan 2012
Effects of nicotine on spinal cord injury pain: a randomized, double-blind, placebo controlled crossover trial.
One factor affecting spinal cord injury (SCI)-related pain may be nicotine. Case reports have described a worsening of neuropathic pain from smoking and relief from abstinence. Neurobiological correlates also implicate the potential effect of nicotine on SCI-related pain. ⋯ Whereas nonsmokers with SCI showed a reduction in mixed forms of pain following nicotine exposure, smokers with SCI showed a converse increase in pain with regard to both mixed and neuropathic forms of pain. The exacerbation of pain in chronic nicotine or tobacco users may not only elucidate possible pain mechanisms but may also be of use in smoking cessation counseling among those with SCI.
-
Nociceptive and neuropathic pain (NP) are common consequences following spinal cord injury (SCI), with large impact on sleep, mood, work, and quality of life. NP affects 40% to 50% of individuals with SCI and is sometimes considered the major problem following SCI. Current treatment recommendations for SCI-NP primarily focus on pharmacological strategies suggesting the use of anticonvulsant and antidepressant drugs, followed by tramadol and opioid medications. ⋯ They express a desire to improve communication with their physicians and learn about reliable alternative sources for obtaining information about their pain and pain management. The discrepancy between treatment algorithms and patient expectations is significant. Clinicians will benefit from hearing the patient´s voice.