Chronic Pain Experience, Pain management Strategies, and Quality of Life in Persons With Spinal Cord Injury in Nepal

Abstract

The descriptive correlational study was conducted to examine the chronic pain experience, pain management strategies, quality of life (QoL), and the relationship of pain intensity and pain interference on the QoL in persons with spinal cord injury (SCI) in Nepal. A total of 120 SCI persons with chronic pain were purposively selected from eight districts of Bagmati Zone, Nepal. The set of questionnaires consisted of (1) Personal, Health, and Environment related Data (2) International Spinal Cord Injury Pain Basic Data Set version 2.0 (ISCIPBDS-2), (3) Pain Management Questionnaire, and (4) World Health Organization Quality of Life BREF (WHOQOL-BREF) (Nepalese version). These questionnaires were validated content by five experts. The intra-class correlation coefficient of pain intensity scale was .91 and Cronbrach's alpha coefficient of pain interference scale and WHOQOL- BREF (Nepalese version) yielded values of .85 and .80, respectively. Descriptive statistics, simple content analysis, and Pearson's Product-moment Correlation were used to analyze data. The results found that the three worst pain locations were (1) back, (2) lower legs/feet and (3) buttocks/hips, respectively. Overall chronic pain intensity was found at a moderate level (M=5.12, SD =1.80). The onset of pain was commonly found within the first six months of injury. Overall pain interference was found at a moderate level (M=4.58, SD =2.30). The majority of persons with SCI reported that they managed pain by themselves at home whenever pain started. Non-pharmacological management methods, including massage (42.50%), exercise (34.17%), and distraction (22%), were commonly used because these methods relieve pain, divert mind, and avoid negative impacts of pain medications. Ibuprofen (25.83%) was commonly used pain medication because it relieved severe pain. The persons with SCI reported that the effectiveness of pain medications was slightly better on pain relief (50.67%) and non- pharmacological pain management methods were also slightly better on pain relief (59.52% -78.94%). The overall QoL of persons with SCI was found to be at a moderate level (M=73.14, SD = 12.90). There was a significant negative correlation of pain intensity and pain interference on QoL (r=-24, p <.01; r = -.48, p <.01, respectively). The results of this study are beneficial for healthcare providers to provide education regarding chronic pain, use of pain medications and their side effects management; use of non-pharmacological pain management, regular pain follow up and evaluation, and reduction of pain interference. Moreover, the environment and physical health should be assessed and supported to improve QoL in SCI persons with chronic pain in Nepal.