Article

OBJECTIVE: To identify the relative importance of positive (facilitators) and
negative (barriers) contributors to living with chronic pain after spinal cord
injury (SCI). DESIGN: Mixed-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. SETTING: University-based research setting and
general community. PARTICIPANTS: Volunteers (N=526) with SCI experiencing
moderate to severe chronic pain. INTERVENTIONS: Not applicable. MAIN OUTCOME
MEASURES: Interview guides, facilitator/barrier statements, and pain inventories.
RESULTS: Exploratory 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). CONCLUSIONS: This 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.
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Langue : ANGLAIS