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Treatments for Chronic Pain Associated With Spinal Cord Injuries: Many Are Tried, Few Are Helpful

Warms, Catherine A. M.N.*; Turner, Judith A. Ph.D.*†; Marshall, Helen M. B.S.*; Cardenas, Diana D. M.D.*

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Objective The objective was to investigate, in two community samples of people with spinal cord injuries, the frequency of use of different pain treatments and the perceived helpfulness of these treatments.

Design and Setting A postal survey was conducted in the community.

Participants The participants were 471 persons aged 18 years or older who had spinal cord injuries and pain. There were 2 separate samples (n = 308 and n = 163).

Outcome Measures The pain treatments used, the helpfulness of these treatments, and the Chronic Pain Grade questionnaire answers were assessed.

Results Respondents reported multiple pain treatments (range of 0–14 and median of 4 in sample 1; range of 0–16 and median of 4 in sample 2). The most commonly reported treatments were oral medications and physical therapy. Medication types most commonly reported were nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids. The treatments rated as most helpful were opioid medications, physical therapy, and diazepam therapy, and those rated as least helpful were spinal cord stimulation, counseling or psychotherapy, administration of acetaminophen, and administration of amitriptyline. Alternative treatments reported as most helpful were massage therapy and use of marijuana. Acupuncture was tried by many but was rated as only moderately helpful.

Conclusions This survey of two large samples of community-dwelling individuals with spinal cord injury–related chronic pain indicates that multiple pain treatments are tried but only a few are rated as more than somewhat helpful. Furthermore, the treatments that are most commonly reported are not always those that are rated as most helpful. The findings point to a number of potentially fruitful directions for future research.

*Department of Rehabilitation Medicine and †Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, U.S.A.

Received April 7, 2001;

revised October 29, 2001; accepted December 5, 2001.

This research was supported by grant 1 PO 1 HD/NS33988 from the National Institutes of Health, National Institute of Child Health and Human Development, and National Institute of Neurological Disorders and Stroke and grant H133N50025–99 from the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, United States Department of Education, Washington, D.C., U.S.A.

Address correspondence and reprint requests to Catherine A. Warms, University of Washington School of Medicine, Department of Rehabilitation Medicine, Box 356490, Seattle, WA 98195, U.S.A.; e-mail: cwarms@u.washingon.edu

© 2002 Lippincott Williams & Wilkins, Inc.