The CONECSI trial: Results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury

Abstract

Many people with spinal cord injury (SCI) rate chronic neuropathic pain as one of the most difficult problems to manage. The aim of the CONECSI (COping with NEuropathiC Spinal cord Injury pain) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI. The intervention consisted of educational, cognitive, and behavioral elements. A total of 61 people were randomized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers. Primary outcomes were pain intensity and pain-related disability (Chronic Pain Grade questionnaire), and secondary outcomes were mood (Hospital Anxiety and Depression Scale), participation in activities (Utrecht Activities List), and life satisfaction (Life Satisfaction Questionnaire). Measurements were performed at baseline, and at 3, and 6 months follow-up. The primary statistical technique was random coefficient analysis. The analyses showed significant changes over time on both primary (t1-t2), and 2 out of 4 secondary outcomes (both t1-t2 and t1-t3). Significant intervention effects (Time*Group interactions) were found for anxiety and participation in activities, but not for the primary outcomes. Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group: decrease of pain intensity, pain-related disability, anxiety, and increase of participation in activities. This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain.

Which Pain Coping Strategies and Cognitions Are Associated with Outcomes of a Cognitive Behavioral Intervention for Neuropathic Pain after Spinal Cord Injury?

“…17,21 A better understanding of how baseline pain coping strategies and cognitions, and changes in such strategies and cognitions, are associated with treatment outcomes could help direct limited resources to those persons most likely to benefit, match patients with the most appropriate treatments, and tailor interventions to patient characteristics. 17 Recently, Heutink and colleagues 22,23 reported the design and results of the CONECSI (COping with NEuropathiC Spinal cord Injury pain) trial, the first randomized controlled trial (RCT) on the effectiveness of a multidisciplinary CBT program for coping with CNSCIP compared with a waiting list control group. No significant intervention effects on the primary outcomes pain intensity and pain-related disability were found.…”

“…Significant treatment effects were found on the secondary outcomes anxiety and participation in activities. 23 The current study utilized data from the CONECSI trial to explore associations between baseline pain coping strategies and pain cognitions on the one hand and pain intensity and painrelated disability on the other, and to study the hypothesis that changes in pain coping strategies and pain cognitions are associated with outcome variables after CBT intervention. The specific aims were to explore changes in pain coping strategies and cognitions during the CBT intervention and to explore (a) associations between baseline pain coping strategies and cognitions and baseline pain and pain-related disability, (b) associations between baseline pain coping strategies and cognitions and the changes in pain and pain-related disability during the RCT, and (c) associations between changes in pain coping strategies and cognitions and changes in pain intensity and painrelated disability during the RCT.…”

Physical therapy after spinal cord injury: A systematic review of treatments focused on participation

“…23 The fifth intervention was a 10-week multidisciplinary cognitive behavioral program. 24 Study characteristics and findings are summarized in Table 1. A total of 191 participants were included in the five studies.…”

“…Three studies were randomized controlled trials (RCTs) [22][23][24] with the control groups of between 13 and 40 participants. The intervention groups ranged from 21 to 40 participants.…”

“…Two of these RCTs used a wait list control design. 22,24 The third RCT compared two different training methods for a home exercise intervention. 22 The other two studies used longitudinal prospective designs (Table 1).…”