Determining the mangement of pain in people with spinal cord injury by physiotherapists in South Africa

Abstract

Pain is a major complaint of people living with spinal cord injury (PWSCI) and has consistently been stated as a difficult problem to manage. Pharmacological, therapeutic, and neurosurgical methods are available for the treatment of pain in spinal cord injury (SCI). Physiotherapy plays a vital role in the treatment of pain related to SCI. Physiotherapy pain treatment encompasses a broad range of treatment modalities (such as electrotherapy and manual therapy) to relieve pain and is widely reported in the literature. However, there is a dearth of literature on what modalities physiotherapists use to treat SCI-related pain in PWSCI. This study aimed to determine the methods, used by physiotherapists in South Africa to treat pain in PWSCI. This study employed a quantitative, cross-sectional design using a therapist-based online questionnaire. Clinical physiotherapists involved in SCI rehabilitation at various facilities and hospitals across South Africa were invited to participate in the study through the South African Society of Physiotherapists (SASP) and the Physiotherapy Association of South Africa (PASA) administrators. Physiotherapists from Gauteng, Free state, Western Cape, Limpopo, Mpumalanga, Eastern Cape and KwaZulu Natal participated in the survey. A non-probability convenient sampling strategy was used. A socio-demographic tool was used to determine the physiotherapist’s demographic information and a self-developed online questionnaire was used to determine the modalities and selection criteria used by the physiotherapists to manage spinal cord injury-related pain. Forty-six valid responses were received. Most of the participants were females (72%), 80% of the participants were clinicians, and 72% of the participants held a bachelor’s degree. The participants were asked to indicate the modalities that they used, separately in the order of their preference. The most used modality was TENS (n=14, 29.8%), followed by exercises (n=13,27.7%), and manipulations and mobilizations (n=14, 29.8%). The factors that guided the selection of TENS were type of pain (87.2%), duration of pain (80.9%), location of pain (83.0%), intensity of pain (85.1%), other treatments that the patient is receiving for pain (83.0%), and the psychosocial factors (87.2%). Almost all participants used outcome measures (100%) and VAS was the most used outcome measure (70%). Similar to the global trend in managing SCI- related pain, TENS was the most used modality to treat SCI- related pain in South Africa. An understanding of the different methods used across the country can help identify the areas where greater efforts in terms of implementation is required. Our study will also help the physiotherapists understand the other available treatment modalities for SCI-related pain. We recommend that a similar study be conducted using a different recruitment strategy to target as many physiotherapists across the nation as possible. This may give a better understanding regarding the current national practices in managing the pain in PWSCI. We recommend that future studies assess the effectiveness of modalities, identify barriers and facilitators to pain management and explore in depth pain management from the patient’s perspective. Key terms: Pain, pain management, spinal cord injury, people with spinal cord injury, physiotherapists, TENS, exercises, mobilization and manipulations, South Africa.